(PDF) Grief in Profession: Self-Compassion, Meaning-making, and Grief from Patient Death

University of the Philippines

Diliman Extension Program in Pampanga

Grief in Profession: Self-Compassion, Meaning-making,

and Grief from Patient Death

Submitted in partial fulfillment of the requirements in APSY 199.2

Macapagal, Angeli Gwyneth D.

Ramirez, Czyr Vielca S.

Bachelor of Arts in Applied Psychology

Adviser:

Prof. Bryan Q. Engay

Applied Psychology Program

University of the Philippines Diliman - Extension Program in Pampanga

2nd Semester, Academic Year 2018-2019

Chapter 1

Introduction

Background of the Study

Do medical professionals grieve when their patients die? As part of their profession,

doctors and nurses are committed to saving their patients’ lives through treatment and cure.

However, one of the most challenging aspects of being in the medical profession is experiencing

the death of a patient. Studies on death and dying predominantly emphasize the needs of the dying

patient and the process of grieving. Most studies currently focus on the grief experienced by the

patient’s bereaved family. However, only a few studies recognize that doctors and nurses

constantly confront death and respond in a variety of ways to the many deaths that they witness

and could likewise generate grief reactions when patients die under their care. As medical

professionals, would it be “unprofessional” if they grieve when faced with the death of a patient

and if they let their emotions get in the way of their work? Do medical professionals not have

emotional responses to their patients’ deaths?

In the medical context, grief is an emotion seldom acknowledged, validated and expressed

for it is considered shameful and unprofessional (Granek, 2012). While a medical professional’s

grief differs from that experienced by the family, it is often experienced nonetheless. In fact,

clinical observations and research findings indicate that medical professionals who experience

repeated deaths of patients acknowledge that they grieve and describe a variety of grief reactions

prior to or after the death of a patient.

Through this study, the researchers wish to acknowledge, validate and understand the grief

reactions, in response to patient death, experienced by medical professionals. Granek (2012)

examined grief reactions among pediatric oncologists and their findings show that reactions to

patient death include sadness, crying, sleep loss, exhaustion, and a sense of personal loss. Also,

Whitehead (2012) reported that medical professionals often experience self-blame, guilt, feelings

of failure and helplessness when faced by the issue of patient death.

In the field of clinical medicine, one of the most challenging aspects of being in it is

experiencing patient loss. The researchers chose to study medical professionals who have

experienced patient death under their care to consider the emotional distress, specifically grief,

that a death of a patient can have among them. Despite the several studies concerning grief due to

loss of a loved one. It is surprising that there has only been a limited amount of literature published

concerning the medical professionals’ personal experience of the death of his or her patient. Also,

the researchers chose to study this topic to affirm that medical professional grief is relevant and to

bring significant contribution and help in addressing the well-being of medical professionals.

One of the primary objectives of this research is to evaluate the severity of medical

professionals’ grief reactions. In an article by Keesee and Neimeyer (2008), the authors identified

the risk and protective factors that determine one’s grief process. They were able to identify

situational, personal and interpersonal risk factors and protective factors such as coping strategies,

protectors deduced from the study of risk factors and, finally, other factors identified from clinical

experience. The researchers chose to research upon and focus on predictor variables of grief on

the medical professional’s personal level. Specifically, the researchers chose to focus on

identifying the roles and relationships of self-compassion, meaning-making, and severity of the

grief reactions that individuals who have experienced patient death.

In relation to the previous paragraph, medical professionals are particularly vulnerable to

stress overload and compassion fatigue due to an emotionally exhausting environment.

Compassion fatigue among caregivers in turn has been associated with less effective delivery of

care. Having compassion for others entails self-compassion, one of the variables of interest in this

study is identified as a robust resilience factor when faced with feelings of personal inadequacy,

feelings of unworthiness, inferiority, failure, and guilt (Dunkley & Grilo, 2007).

The researchers chose to study self-compassion, and meaning-making, the other predictor

variable chosen for this study, for these involve the adaptive significance of being compassionate

to oneself and making sense or finding benefit in loss - in the case of the present study, loss will

be the death of a patient under the care of health professionals. In essence, these variables were

selected for the researchers hypothesize that these could predict the grief reactions of medical

professionals when their patients die.

Objectives of the Study

The primary aim of this research is to address the issue of grief amongst medical

professionals’ in response to patient death and understand the different variables behind their grief

reactions. Specifically, the researchers aim to:

• test the relationship of self-compassion with grief reactions in response to patient death;

• test the relationship of meaning-making with grief reactions in response to patient death;

• test if there is a relationship between self-compassion and meaning-making of medical

professionals who have experienced patient death;

• determine and find out which is the better predictor among the variables - self-compassion,

meaning-making, - of grief reactions in the context of patient death

• compare nurses’ and doctors’ severity of grief reactions in the context of patient death

• compare nurses’ and doctors’ level of self-compassion in the context of patient death

• compare nurses’ and doctors’ level of meaning-making in the context of patient death

This study also aims to understand the relationships between self-compassion, meaning-

making, and grief of medical professionals who have experienced patient death. Therefore, the

researchers conducted a qualitative study to look into the personal experiences of these medical

professionals. In detail, the primary objective of the qualitative part of the research is to:

• know how doctors and nurses perceive their work as medical professionals;

• explore medical professionals’ grief reactions over patient death;

• know the factors that affect the experiences of medical professionals;

• examine the impact of patient death has on the personal and professional lives of medical

professionals;

• explore their use of coping and social resources to manage their grief reactions;

• identify and describe the role of self-compassion with the grief reactions of medical

professionals to patient death; and

• identify and describe the role of meaning-making with the grief reactions of medical

professionals to patient death.

Statement of the Problem

This study is a mixed-method study designed to examine grief reaction intensities in

response to patient death amongst medical professionals and determine the relationship of these

intensities with the medical professionals’ levels of self-compassion and meaning-making.

Specifically, the researcher aims to answer the following questions:

1. Is there a relationship between self-compassion and the grief reactions of medical

professionals?

2. Is there a relationship between meaning-making and the grief reactions of medical

professionals?

3. Is there a relationship between the self-compassion and level of meaning-making of

medical professionals?

4. Which of the variables will be the better predictor of grief reactions from patient death

among medical professionals?

5. Is there a significant difference in nurses’ and doctors’ severity of grief reactions in

response to patient death?

6. Is there a significant difference in nurses’ and doctors’ level of self-compassion in the

context of patient death?

7. Is there a significant difference in nurses’ and doctors’ level of meaning-making in the

context of patient death?

In the qualitative part of this study, the researchers would want to understand the

relationships between self-compassion, meaning-making, and grief of medical professionals who

have experienced patient death. Moreover, the researchers intend to find answers to the following

questions:

1. How do doctors and nurses perceive their work as medical professionals?

2. What are the reactions of medical professionals to their experience of patient death?

3. What factors affect the experiences of grief reactions by medical professionals in the

context of patient death?

4. How does the death of a patient affect the personal and professional lives of medical

professionals?

5. What are the coping strategies and social resources used by medical professionals to

manage their emotions?

6. What is the role of self-compassion among medical professionals in handling patient

deaths?

7. What is the role of meaning-making among medical professionals in handling patient

deaths?

Research Hypotheses

The researchers of this study hypothesize that grief reactions are negatively correlated with

both meaning-making and self-compassion. Moreover, the researchers also hypothesize that self-

compassion will come out as the better predictor than meaning-making. Based on the researchers’

gathered references for this study, the following hypotheses will be tested:

H1: Self-compassion is negatively correlated with the severity of medical professionals’ grief

reactions in patient death.

H2: Meaning-making is negatively correlated with the severity of medical professionals’ grief

reactions to patient death.

H3: Self-compassion is positively correlated with meaning-making of patient death.

H4: The better predictor of grief reactions among medical professionals is self-compassion.

H5: Self-compassion of doctors is greater than nurses in the context of patient death.

H6: Meaning-making of doctors is greater than nurses in the context of patient death.

H7: Nurses are more likely to experience severe grief reactions than doctors in the context of

patient death.

Significance of the study

Death has always been a natural part of a person’s life. A medical professional’s work

focuses largely on treatment and cure, but care of the dying and bereaved are also part of his or

her duties. After the death of a patient, hospital protocols require medical professionals to help in

the bereavement of the dead patients’ families. However, these doctors and nurses may feel ill

prepared to do so. In this research, we want to affirm that medical professionals, even though

expected not to, can potentially experience grief reactions over the death of their patient.

A lot of published work is evident on describing stress, grief, and loss of families but there

is less study and explanation on how clinicians and medical professionals deal with similar issues.

Through this research, we aim to find out how the medical professionals exhibit their grief and

measure their grief severity, which includes symptoms of despair, blame and anger,

disorganization, detachment, and panic behavior. The researchers also aim to help them ease some

of the negative consequences that their grief reactions have for the medical professionals

themselves. Some examples of negative consequences include lasting emotional reactions,

questions of competence, work-stress, and risks of professional burnout as Redinbaugh (2001)

mentioned the implications of grief-related jobs.

By examining the severity of grief reactions and its relationship to self-compassion and

meaning making, this study will provide results that would aid medical professionals when coping

with loss. Doctors and nurses are involved in issues of death and dying on a daily basis and

inevitably, as part of their professional practice, have contact with patients who die. Therefore, it

is important to acknowledge that care of the dying and the principles of patient care are

increasingly becoming an important issue in healthcare, bringing difficulties and dilemmas for

medical professionals. In order to contribute to the improvement of medical services, the

researchers would like to understand and discuss the medical taboo on grief experiences that

medical professionals are thought to have. Hopefully, this study could shed some light on the

hidden and sometimes disregarded experiences of medical professionals who are exposed to

multiple deaths of patients and make a way for them to experience grief like everyone else.

Understanding the emotional reactions of these professionals to patient death is one of the

primary purposes of this study. Through this phenomenological study, the emotional demands of

clinical practice could be determined from the nature of their experiences and lead to the

development of strategies for the effective dealing with patient death and resolving of these losses.

All of these, for future studies about Filipino healthcare professionals and for the medical

professionals themselves. For them to understand themselves and face the daily experiences,

especially negative ones, that come with work with less stress.

This research will also serve as a future reference for studies in the field of Positive

Psychology and as well as in Counseling Psychology. Roberts et al. (2016) supplied support on

the viewing of grief in positive psychology to meet a process of coping that is normalized and also

effective. By understanding grief, cognitive and behavioral approaches could be applied in

meaning-making and self-compassion. With this research, these mentioned areas in psychology

will have a thorough connection to our variables, thus would possibly generate new effective

methods on coping with grief. The researchers will collect strong evidence in this research that

would suffice for its contribution to the field of psychology. Additionally, the researchers will

contribute to the limited literature on the grief of medical professionals through providing a

characterization of this population based on their grief reactions, meaning-making, self-

compassion, and coping strategies used.

Lastly, the grief of medical professionals interests the researchers because they wanted to

affirm that the experience of grief due to patient death is fairly ubiquitous among medical

professionals. They wanted to know if it is possible to grieve over a person you aren’t even related

to. They wanted to know the factors that affect the severity of grief a medical professional could

experience because of a patient’s death. The researchers wanted to know how these medical

professionals who have encountered numerous deaths deal with the grief that comes with it. Most

importantly, they wanted to determine the relationship between their meaning-making, self-

compassion, profession and the severity of medical professionals’ grief reactions.

Scope and Delimitations

The focus of this study is on the grief reactions of medical professionals with regards to

patient death. The researchers analyzed data on the severity of grief reactions of the participants

with their levels of self-compassion and meaning-making. Data for this study were based on the

experiences of medical professionals who have prior experience of patient death under their care.

The researchers utilized a mixed-method research design, which included both quantitative

method and qualitative method. The quantitative part, a descriptive-correlational study of medical

professionals’ grief reactions to patient death, was employed in testing the relationships of the

variables and in making the results more generalizable. The data needed for this part of this study

were gathered via self-report methods and tools such as the Hogan Grief Reaction Checklist

(HGRC) by Hogan, Greenfield, & Schmidt to measure severity of grief reactions, the Self-

Compassion Scale - Short Form (SCS-SF) by Kristin Neff to measure self-compassion, and the

Grief and Meaning Reconstruction Inventory (GMRI) by Gillies, Neimeyer, & Evgenia.

For the qualitative part, the researchers aim to determine and understand the different

predictors of grief and to explore on their personal experiences of patient death, its impact to their

lives as medical professionals and the mechanisms they used to cope with the experiences that go

with their profession especially the experience of loss. In order to gather additional information

that will help in further understand their experiences, the researchers conducted qualitative

research in the form of semi-structured interviews, guided by questions drafted by the researchers

themselves.

This study focused and researched upon the following variables or predictors: grief reaction

severity, self-compassion and meaning-making. Moreover, the participants of this study were

doctors (general practitioners, oncologists, internists, surgeons, family medicine specialists,

resident doctors, senior interns, and clerks) and nurses working in public and private hospitals in

Pampanga and Metro Manila. Purposive sampling will be utilized to gain access to people who

have experienced patient death under their care at least once. Studies show that several reports

from emergency and intensive care departments in hospitals have high acuity on mortality rate

(Siddiqui, 2015; Salazar, Bardés, Juan, Olona, Sabido, & Corbella, 2005), so the researchers

focused on the doctors and nurses currently appointed or have been appointed at these departments.

For the quantitative part of the study, 115 medical professionals were asked to answer a survey.

Meanwhile, 12 people were interviewed in the qualitative part of the study. All of the participants

were gathered from Pampanga and Metro Manila. Therefore, the results of the research could not

possibly be generalizable to the entire population of medical professionals due to these

constraints.

Chapter 2

Review of Related Literature

This study regarding the relationship of medical professionals’ grief reactions with self-

compassion and meaning-making aimed to contribute information to the growing body of research

that explore medical professionals’ experiences of dealing with patient death and to understand

how these experiences affect them. Accordingly, it needs foundation and elucidation with the use

of previous studies and researches related to the said topic. In line with this, the researchers

accomplished an extensive assessment and evaluation of several studies in order to build the

foundations of this research.

Grief and Grief Reactions from Loss

Grief is a common topic researched thoroughly as it is one of human life’s inevitable

experiences. As frequently stated in this paper, many studies about grief are associated more with

families and relatives but too little number accounts with grief experienced by the medical

professionals who witnessed deaths of their patients. This study on the relationship of meaning-

making and self-compassion with grief reactions of the medical professionals will contribute to

the introduction of the said topic to both fields of medicine and psychology. The references that

served as foundation to this research are limited, but sufficient enough to elucidate the nature of

this study.

To start, Tal Young and her fellow researchers (2012) defined grief as a universal,

instinctual, and adaptive response to a death. People can come to an agreement that grief is

necessarily and obviously experienced by those with close relationships to someone who has

passed away. However, the severity of grief and the type of grief reactions they experience vary

from one person to another. A study about grief reactions, but on close family caregivers, state

examples of grief reactions like feeling the need to cry and being upset when thinking about the

person who passed away (Chentsova-Dutton et al., 2002).

With this information, it can be assumed that interpersonal connection is one variable that

would result to a person’s grief, thus, the connection built between the medical attendant and

patient could possibly give reason for grief reactions experienced by the medical professionals.

Science and News (2018) believed that mourning for strangers is possible. Therefore, grief of

medical professionals should be as normal as grief experienced by those related to the patient.

According to Zisook and Shear (2009), grief is summarized as response to loss whether

emotional, cognitive, functional, and behavioral. Dealing and discussing grief within the medical

field seemed to become a hindrance to their profession. Nonetheless, this doesn’t exempt medical

professionals from experiencing grief for their patients. Redinbaugh et al. (2001) affirmed this by

stating that work situations of healthcare professionals has an effect to create grief among them.

Medical professionals encounter patients with different types of diseases. They diagnose and even

find for a treatment for their patients. As unfortunate as it can be, not all situations with their

patients are a success, and, most of the time, medical professionals witness and experience loss

more than other individuals. The same study also explained how different medical professionals

react to grief.

Shear (2012) stated grief as “reaction to bereavement, comprising thoughts, behavior,

feelings, and physiological changes that vary in pattern and intensity over time”. Generally, grief

reactions differ depending on an individual’s experience of loss (Zisook & Shear, 2009). A study

that explores the scope with which grief varies, and what would be considered as common and

normal grief. This also provided information on what determines what type of grief could soon

develop to something abnormal and pathological depending on the severity of the grief they

experienced and on the length of their grieving process (Bonnano and Kaltman, 2001). The type

of grief reaction that the participants of this study often process or have processed within

themselves, can be examined using the information from the recent study.

Compassion & Self-Compassion

The dictionary defines compassion as a deep awareness of others’ suffering and the wish

to alleviate it. According to Kret (2011), compassion is something intrinsic to health care practice.

Figley (2002) states in of of his articles that “...we cannot avoid our compassion and empathy.

They provide the tools required in the art of human service. To see the world as our clients see it

enable us to calibrate our services to fit them and to adjust our services to fit how they are

proceeding.”

As medical professionals, their empathic ability allows them to notice the pain of others

and be compassionate towards those who are in pain. But ironically, this empathic ability of theirs

is also related to the susceptibility to stress, burnout, and emotional exhaustion (Davidson &

Harrington, 2002). Self-compassion then comes in handy, the basic kindness, with a deep

awareness of the suffering of oneself and others (Gilbert, 2009). Self-compassion has been linked

to greater levels of things like increased resilience and well-being and lower levels of depression,

anxiety, and stress. Neff (2003) states that self-compassion involves being open to and moved by

one’s own suffering, experiencing feelings of caring and kindness towards oneself, taking an

understanding, nonjudgmental attitude toward one’s inadequacies and failures, and recognizing

that one’s own experience is part of the common human experience. Exposure to patient death, an

event of loss that could cause subsequent trauma, depression, and guilt may be associated with

self-blame and self-criticism. Therefore, the researchers examined the relationship between self-

compassion and grief.

Role of Self-compassion in Grief

Grief is defined as deep mental anguish arising from loss. Grief sometimes involve feelings

of guilt, regret, shame, low self-esteem, and loss of identity (Granek, 2012). Since death and loss

are intrinsic aspects of a medical professional’s practice, they have to deal with grief and to make

things even more challenging.

Medical professionals, when faced with the death of a patient so quite often struggle with

thoughts like – “I wasn’t a good doctor/nurse/etc” “The death was my fault”. Thus, examining

medical professionals’ self-compassion is a significant issue. So, grieving people should be

especially mindful of their self-critical voice and how loud it can become. The possible roles of

self-compassion is to promote mental well-being, lessen feelings of self-loathing, and counter

chronic self-criticism without requiring that one adopt an unrealistically positive view of oneself

(Leary et al., 2005).

Meaning-Making

Meaning-making, likewise self-compassion has deep spiritual roots, and both confer

significant mental health benefits, they have this interesting connection. There are numerous ways

to define meaning making. Although meaning-making and coping share similar attributes, they

represent different constructs. “Meaning-making consists of the processes of how an individual,

couple, or family makes sense of an experience or event” (Bonanno, Wortman, Lehman, Tweed,

Haring, Sonnega, Carr, & Nesse, 2002, p. 1151). Meaning-making, in this study, is defined as

making, finding or reconstructing meaning in the aftermath of a medical professional’s loss of a

patient. The way in which individuals structure their reality or interpretation of the world can have

a significant impact on how meaning-making from a loss is derived. Individuals make meaning on

a regular basis. We want to make sense out of our life events and our experiences, most especially

stressful ones. According to Gillies and her colleagues (2014), meaning-making is defined as

negotiating the challenge that the loss event represents to one’s meaning system. Discrete types of

meaning-making process include sense-making, benefit-finding, continuing bonds, and identity

reconstruction (Gillies & Neimeyer, 2006).

Role of Meaning in Grief

Everyone has already experienced or will experience grief (from a death) at some point in

their lives, but people often get caught up in thinking about how their experiences differ. Grief is

something that feels different for everyone and no two people grieve in the exact same way. The

severity of grief may depend on many variables; personality, cultural factors, social roles, and even

the meaning-making of a person. Research suggests that bereaved persons are at high risk for grief,

and that meaning making is associated with a reduction in the severity of these reactions.

(McIntosh et al., 1993; Murphy et al., 2003).

It is foreseeable that an individual’s ability to find meaning in a death may be related to the

amount of experience he or she has with death and dying. In the case of medical professionals,

these individuals may have had a significant number of death-related experiences already and may

have developed skills and expertise at making meaning with such experiences. Because of the

nature of their work, medical professionals are hypothesized to have lower severity of grief

reactions with high meaning making. The current study will examine the relationship of grief with

meaning-making within this sample of individuals.

Medical Professionals and Dying Patients (Attitudes toward Patient Death)

An insight from the study of Redinbaugh et al. (2003) provided a standpoint wherein

doctors and other healthcare professionals that spend time with their patients are more vulnerable

on their patient’s death. According to Smith-Han et al.’s (2016) study on the experiences of

medical students on death of their patients, they serve as lessons on how they would prepare as a

professional doctor in the future. These experiences give them actual understanding on how they

would handle future situations regarding deaths of their patients.

Experiences of medical professionals on death of their patients could vary on which

department they are in. For example, the in‐patient death rate in the emergency department of a

hospital measured by Baker and Clancy (2006) reports 4.6% as the number of in‐patient deaths or

number of emergency admissions and interpreted as one-third out of all patient deaths in that

hospital. This background data would give an idea on how grief reactions of medical professionals

assigned in this department could differ from other departments based on how much patient’s death

they witness.

Impact of Patient Death on Medical Professionals

The impact of patient death among medical professionals can be seen through their

personal lives and work behavior. On their personal lives, patient death affect directly the

emotional health of the medical professionals. In a study of Kelly and Nisker (2010), the

researchers found that the tension between emotional concern of the participating medical students

for their patient and the family of the patient associates with their experiences on the death of their

patients. Hence, it makes them feel the need to detach themselves. The death of the patient also

affects the physician’s personal growth (McQuade, 1992). Just like other common life experiences,

their grief experiences on patient loss will certainly leave a mark and meaning to their life. For

their work behaviors, Pantil and Isaac (2008) explains the importance of introduction and

awareness on the themes of emotional concerns of medical professionals on patient death

experiences can avoid burnout.

Existing Coping Strategies in Dealing with Patient Deaths

Dealing with grief could take a long process, but it mostly depend on how an individual

handles it. On the medical professionals’ side, Redinbaugh et al. (2003) stated a situation in their

study wherein the process of dealing with grief and patients’ death includes debriefing on their

department, sharing of emotional response, and reflecting from the experience. Hegedus et al.

(2002) studied how family physicians react to grief among death of patients and found that the

participants generally shared that they avoid communicating to each other about the topic. Coping

strategies on grief can be adaptive and maladaptive depending on what would fit in the medical

professional’s style while considering their occupational interests (Redinbaugh et al. 2001.) This

study addresses that coping strategies also has indefinite examples but affirms that any way could

possibly help medical professionals to cope with grief as long as it works for them.

Theoretical Framework

The main objective for pursuing this study is to provide support to our presupposition that

medical professionals do have emotional responses to their patients’ deaths, perhaps including

feelings of grief, guilt, loss, depression, helplessness, sadness, anger, incompetence, and

frustration, even with the existence of a societal expectation that expects medical professionals to

remain “professional” by not allowing emotions get in the way of their work. Additionally, the

core concept that will be studied in this research will be the relationship of severity of grief

reactions with the level of self-compassion and the meaning-making in the context of patient death

of medical professionals in Pampanga. In this section, the researchers will present the theories

that will serve as foundation for pursuing the study.

The question of whether medical professionals grieve or not when faced with the death of

their patients is one of the main topics of this research. The researchers acknowledge that there

may be differences in the emotions that medical professionals could possibly feel and in the ways

that they manage their emotions. Emotion management is the act of inducing or suppressing feeling

in order to sustain the socially accepted and expected emotional response (Hoschild, 1983). To

apply this in the medical context, this could be recognized as the processes by which the medical

professional must manage in accordance with his or her profession’s rules and expectations

(Wharton, 2009).

Emotional management is informed and regulated by the concept of feeling rules. Feeling

rules address the proper extent, direction and duration of a feeling in a given situation (Hochschild,

1979; Wharton, 2009). Medical professionals are expected by society that they remain

“professional” by not allowing emotions, even emotions that come from death, to get in the way

of their work. Naturally, these medical professionals internalize this expectation from others for

themselves. The researchers think that this could be explained by the theoretical perspective of

Social Structuralism that gleans from the Role Theory, a collection of concepts and a variety of

hypothetical formulations that predict how actors will perform in a given role, or under what

circumstances certain types of behaviours can be expected (Conway, 1988). Social structuralism

focuses on society, social systems, and the social structure, which are seen to shape behaviour.

In relation to this, another theory that the researchers will use is the theory of social

mentality. This theory suggests that there are internal systems that “generate patterns of cognition,

affect, and behaviour that allow for enactment of social roles (Gilbert, 2000). A social mentality

is said to orient a person to create certain roles with others and guide interpretation of the roles

others are enacting. Therefore, Gilbert (2000), suggests that social mentalities are activated in

relations within the self, and that social mentalities underlie self-compassion. Object relations

psychoanalytic theory will also be used as this theory suggests that the way an individual relates

to himself or herself is a reflection of how their various internal objects ( in this case, self-objects)

relate to each other. An individual who hates himself/herself will have his or her self-objects

attacking and destroying each other.

Lastly, as meaning-making is also included as one of this study’s variables, it is appropriate

to also include theories or approaches that could help better understand the construct. In this case,

the constructivist approach to psychology is one that could emphasize individuals’ need to

construct and maintain a sense of meaning in their lives and experiences (Neimeyer, 2010).

Constructivist theorists often cite the work of Frankl (1992), who asserted that “the quest for

meaning is the key to mental health and human flourishing” (p. 157), which allows individuals to

overcome even the most tragic events. Constructivist theorists propose that the effort to find,

create, or reconstruct meaning is one of the core elements that could help in grief and bereavement.

Conceptual Framework

By integrating the findings of reviewed studies about Grief Reactions, level of self-

compassion, and meaning-making of loss, the researchers came up with the conceptual model to

guide in the discussion of the research.

In this study, Figure 1 shows that the grief reactions of medical professionals in response

to patient death has a relationship with self-compassion and meaning-making. With that, double-

headed arrows were used to connect the severity of grief reactions to levels of self-compassion and

meaning-making. Based on what the researchers hypothesize for this study, severity of grief

reactions to patient death has a negative relationship with level of self-compassion and meaning-

making. Thus, (1) the higher the level of self-compassion the lower the severity of grief reactions;

and (2) the higher the level of meaning-making the lower the severity of grief reactions.

Furthermore, Figure 1 shows that a double-headed arrow also connects self-compassion and

meaning-making. This is because the researchers, based on the previous studies, also hypothesize

that there is a positive relationship between level of meaning-making and self-compassion. In other

words, the researchers hypothesize that self-compassion increases as the level of meaning-making

increases.

Figure 1. Conceptual diagram of the study

Definition of Terms

• Patient death: Death is defined as the cessation of all vital functions of the body including

the heartbeat, brain activity, and breathing. However, patient death as used in this study, is

the death of a patient in a hospital while under the care of a medical professional.

• Grief: Mosby’s Medical Encyclopedia defines grief as a pattern of physical and emotional

responses to separation or loss. For the purpose of this study, grief is the process by which

medical professionals experience to adjust to the loss or death of a patient.

• Grief reactions: This study refers to grief reactions as emotional reactions such as sadness,

guilt, and stress caused by caring for dying patients. This term was utilized from a study

about doctors’ emotional reactions to recent death of patient by Redinbaugh et al. (2003).

The grief reactions will be the experiences and reactions extracted from interviews with

medical professionals and their scores on the scale instrument (Hogan Grief Reaction

Checklist) measuring the severity of grief reactions experienced by medical professionals

towards patient death.

• Self-compassion: The researchers adopted Neff (2010) definition of self-compassion which

is “being touched by and open to one’s own suffering, not avoiding or disconnecting from it,

generating the desire to alleviate one’s suffering and to heal oneself with kindness” for this

study. This variable will also be extracted from a scale instrument (Self-Compassion Scale -

Short form) which examines the level of compassion towards oneself of these medical

professionals in instances of pain or failure.

• Meaning-making: In this study, it is the process of finding meaning in loss and negotiating

the challenge that the loss event represents to one’s meaning system. By making sense of the

patient’s death under their care and finding benefit in the experience, meaning is made,

found, or reconstructed. The meaning made of a patient’s death to a medical professional

will be measured using single-item questions on a Likert type scale and a scale instrument

(Grief and Meaning Instruction Inventory).

• Medical professionals: In this study, medical professionals are those individuals in the

medical profession. The researchers chose to focus on doctors and nurses who have

experienced patient death in their care at least once, and currently rotating or rotated within

the year at the emergency and intensive care departments of hospitals. In this study, they are

the initial witnesses of their patient’s death.

Chapter 3

Methodology

Research Design

The researchers applied a mixed-methods approach to acquire the information needed for

this study. This research design has gathered qualitative data to support prior quantitative data. For

the quantitative data, the researchers utilized a descriptive-correlational design. The participants

were asked to answer three scales measuring their grief reactions, self-compassion and meaning-

making. Using the data derived from these scales the levels of the relationship of these variables

was tested.

In addition, the researchers conducted interviews to gather qualitative information that

would supplement and explain the quantitative findings. A qualitative design guided by a

phenomenological approach was used to interpret the lived experiences of medical professionals

regarding their patients’ death. Interview questions were regarding the medical professionals’

personal experiences with patient death, its impact on their lives, and their coping strategies.

Participants

The population of the study composed of medical practitioners and nursing professionals

who have experienced the death of a patient for whom they had cared. Medical practitioners who

were included in the sample for this study are general practitioners, oncologists, internists,

surgeons, family medicine specialists, resident doctors, post-graduate interns, medical clerks, also

known as junior interns, and nurses. The aforementioned professions were chosen by the

researchers because of their known direct and frequent interactions with patients. The criteria for

selection involved doctors and nurses, who have experiences with patient death. The licensed

physicians and registered nurses must have been working as practitioners for at least a year in their

respective fields and most importantly, should have had experience with a patient dying in their

care were chosen. The resident doctors, post-graduate interns, and medical clerks chosen are those

who have had experiences with patient death, although there were no limitations as to the length

of time they should have spent as residents or interns. There were no restrictions in terms of age,

gender, religion, and socioeconomic status of the participants. However, the medical professionals

targeted were those who are currently working in public or private hospitals in various areas in

Pampanga and Metro Manila, preferably but not limited to those professionals who work in the

intensive care departments. The researchers were able to find 115 medical professionals who

participated in the quantitative part of the study.

Purposive sampling was used as a method to gather the participants for this study because

this method permits the researchers to select participants who have experienced the phenomenon

to be investigated (medical professionals who have experienced patient death). As for the

qualitative part of the study, twelve (12) participants were also purposively selected. The five (5)

participants who scored the highest, two (2) participants who had average level scores, and five

(5) who scored the lowest in the Hogan Grief Reaction Checklist, were selected from the pool of

the survey participants. Through this way, the researchers will be able to gather data from different

perspectives, differentiate between the high-scorers and the low-scorers, and most importantly,

generate more information about the variables in the context of those who have severe grief

reactions and those who don’t. However, the acquired participants in this study proved to have

busy schedules therefore, some of the highest and lowest scorers were not available for interview,

the researchers had to compromise and use a convenience sampling method and included

participants who had average level scores as well.

Data Collection Methods

Procedure

To gather participants for the study, the researchers used an online survey and went to

different public and private hospitals in Pampanga and submitted an institutional approval letter to

request for their participation in the study and to ask permission to conduct scale administration.

After obtaining approval from the institutions, participants were recruited to participate in the

study. The researchers asked for assistance and help in finding participants that can take part in

the study and in the distribution and retrieval of the survey forms. Online respondents were

required to read the informed consent form before answering the survey questionnaire. When they

agreed to participate, the instruments were presented with a demographic data form first, followed

by the HGRC, SCS-SF, and GMRI. All participants completed the self-administered

questionnaires.

When all the responses required for the quantitative portion of the study have been

obtained, the researchers evaluated the data by encoding them to a software for further organization

to sort out valid and invalid responses before data analysis. Through this evaluation, the

researchers were also able to identify their target participants for the qualitative part of the study.

Participants who were identified as low and high scorers in the Hogan Grief Reaction Checklist

were contacted by the researchers to participate in an interview. The participants were asked how

and where they liked to have the interview proper (e.g., through voice call, face-to-face

conversation, etc.). This was to ensure that the participant will be comfortable throughout the

process and the conditions would be convenient for them.

Prior to conducting each semi-structured interview, the participants underwent a short

briefing that will inform them of the purpose and significance of the study. They were given a

short period of time for clarifications and questions. The researchers also gave another informed

consent form to the participants to affirm that their participation in the study is voluntary and that

they have the right to withdraw from the study and the limits of confidentiality. The participants

were also be made aware of the data recording procedures (i.e. audio clip recording and note

taking) and their importance in data analysis.

Once the introduction, comfort and rapport has been established with the participants, the

researchers proceeded with the interview. The participants were inquired about their experiences

of patient death, the roles self-compassion and meaning making have on their grief reactions, the

impact of these experiences on their personal and professional lives, and the coping mechanisms

they use in dealing with loss. The researchers utilized an interview guide with possible probing

questions that are relative to the situation. After the interview, the researchers informed the

participants that the results obtained from the interviews will be validated with them before data

analysis and that the final manuscript will be made available to them upon their request. Interviews

were conducted in a private, quiet environment, a place of the participants’ choosing. Most

participants were interviewed in their workplace. As stated earlier, interviews were audio recorded

and transcribed verbatim. Interviews lasted approximately 45 minutes to 1 hour, depending on how

much information the participants wanted to share with the researchers.

Instruments

The instruments that the researchers used for this study includes a demographic

questionnaire, three scales that show good reliability and validity in general populations measuring

the three variables involved as part of the quantitative perspective study, and an interview guide

containing questions that will support the data gathered prior the qualitative part of the study.

Quantitative Data

Hogan Grief Reaction Checklist (HGRC)

For grief reactions, The Hogan Grief Reaction Checklist (HGRC) by Hogan,

Greenfield, & Schmidt (See Appendix B) was used by the researchers to measure the

participants’ severity of grief reactions following the death of a patient. HGRC is a 61-item

self-report measure designed to measure the many dimensions of the bereavement process.

This scale was developed as a response to the lack of psychometrically sound instruments

available for studying grief. In past studies, the HGRC has an internal consistency

(Cronbach’s alpha) of 0.90 for the total scale and ranged from 0.82 to 0.90 for the subscales.

The HGRC subscales are as follows: Despair (assesses hopelessness and loneliness); Panic

Behavior (fear and somatic symptoms); Blame and Anger (irritation and feelings of

injustice); Disorganization (difficulty with concentrating and problems with retaining and

recalling information); Detachment (disconnectedness from oneself and others); and

Personal Growth (becoming more compassionate, caring, and forgiving).

The general instructions of the scale ask the respondent to complete the

questionnaire that are based on how they have been feeling about a death of the patient,

that has been most difficult for them, on a 5-point scale (1 = does not describe me at all to

5 = describes me very well). Scores are computed by summing the responses on each scale.

The higher the score the respondent gets, the more severe his/her grief reactions are or once

were. Research has demonstrated that the five grief scales of the HGRC (Despair, Panic

Behavior, Blame and Anger, Disorganization, and Detachment) can be combined reliably

into a unitary measure of grief intensity (Gamino et al., 2000). The Personal Growth scale,

on the other hand, negatively correlates with the other five scales, which does not allow a

total HGRC score to be computed. Thus, the Personal Growth scale is reliably connected

to the summed grief intensity score and is used as a separate scale in grief research (Hogan

& Schmidt, 2002). Therefore, the researchers will make use of the grief intensity score as

an outcome measure for analysis and then use the results of the personal growth subscale

separately.

Self-Compassion Scale – Short Form (SCS-SF)

For self-compassion, participants were given the 12-item Self-Compassion Scale -

Short Form (SCS-SF) by Kristin Neff (See Appendix C). This version is a short form of

the 26-item Self Compassion Scale (Neff, 2003), the SCS–SF demonstrated adequate

internal consistency (Cronbach’s alpha ≥ 0.86) and a near-perfect correlation with the long

form SCS (r ≥ 0.97). This form includes six subscales that measure an individual’s level of

self-kindness, self-judgement, common humanity, isolation, mindfulness and over-

identification. Responses were given on a Likert scale from 1 (almost never) to 5 (almost

always) with the total score then averaged (after reverse-coding negative subscale items -

self-judgment, isolation, and over-identification) to create an overall self-compassion

score. A person with a high score on this scale implies he or she has the ability to be

compassionate towards oneself in instances of pain or failure.

Grief Meaning and Reconstruction Inventory (GMRI)

Meaning making levels were assessed as a deliberate process. The time frame for

all meaning making measures were “in their life as a medical professional”. Meaning-

making of a participant was assessed with three subscales from the Grief and Meaning

Reconstruction Inventory (GMRI) assessing Personal Growth, Sense of Peace, and

Emptiness and Meaninglessness by Gillies, Neimeyer, & Milman (See Appendix D).

Questions were rated on a Likert scale from 1 (strongly disagree) to 5 (strongly agree) with

the total score summed after reverse-coding negative subscale items - emptiness &

meaninglessness) to create an overall meaning-making score. When an individual scores

high in this scale, the individual is said to be able to make sense of the patient’s death well

and able to find benefit from the experience.

Qualitative Data

Aside from these scale instruments, the researchers will also use an interview guide

drafted by the researchers themselves (see Appendix E) which contains questions

following-up on the answers of the participants in the abovementioned scales and also,

questions exploring the medical professionals’ personal experiences, grief reactions, and

their coping strategies. The researchers used literature review to generate questions

relevant to medical professionals’ experiences of patient death.

Data Analysis

The quantitative part of this study was analyzed through correlational analyses. The

researchers used the scores from each test to determine Pearson’s correlation coefficient (α = 01,

1-tailed). This statistical method is used in investigating relationship between two variables. In this

study, the researcher investigated three correlations: 1) relationship between severity of grief

reactions and level of self-compassion; 2) relationship between severity of grief reactions and

meaning-making; and 3) relationship between level of self-compassion and meaning-making.

Pearson’s correlation coefficient (r) measures the strength and identifies the direction of a linear

relationship between two interval/ratio variables (Howitt & Cramer, 2005).

After determining the Pearson’s correlation coefficient, the researchers conducted a

multiple regression analysis in order to find out which of the variables is the better predictor of the

severity of grief reactions. At the same time, regression analysis will also be able to test whether

there is a collinearity among the predictor variables. Collinearity refers to the phenomenon where

the predictor variables are related to each other.

The researchers then analyzed the qualitative data gathered from the individual interviews

by employing thematic content analysis. First, the researchers transcribed the interview responses

verbatim. Second, the researchers separately coded the transcripts by extracting significant

statements that the researchers deemed important from the responses provided by the interviewees.

Analysis involved discussions to refine a coding scheme and ensure consistency between the

researchers’ analyses. Analysis was inductive, line-by-line coding was used and significant words,

phrases, and statements were highlighted. After coding several transcripts, the codes and categories

were then compared and refined to identify the major themes and sub-themes. A total of seven sets

of potential themes were generated from the patterns of explicit as well as implicit responses of

the respondents. Constant comparison by the researchers was also used throughout the process of

analyzing the data to examine relationships within and across themes and ensure the validity of

findings. To ensure that the researchers accurately represented the participants’ responses, findings

were returned to the participants for further validation.

Ethical Considerations

The researchers had to address some ethical issues since the topic of this study requires

responses regarding the medical professionals’ personal experiences and emotions, which are

somewhat sensitive matters. First, participants were ensured that they have the right to not

participate in this research. If they give their consents, researchers reassured the participants that

the data given by the participants in this study will be kept confidential and will be solely used for

academic purposes only. The participants were also briefed about the purpose and nature of the

study. By knowing the purpose and nature of this study, the participants will be able to cooperate

well and understand their importance and role in the completion of this research.

For the participants of the qualitative part of the study, the participants were reminded that

they have the right to withdraw their participation on the event that they no longer feel comfortable

in participating in the study. As the questions regarding their personal experiences could possibly

trigger unwanted emotions for some, the researchers were observant of the participants. Whenever

the participants are recalling their experiences for this research, the researchers had to be observant

of the tone of the participants’ voices, as well as their non-verbal language along the processes of

the research.

The researchers also informed the participants that the interview will be recorded through

an audio recorder for documentation purposes. In line with this, the researchers again assured

confidentiality of the data collected from them and that aliases will be used to conveniently

describe the participants’ responses in the results. Also, for those who expressed their interest in

knowing the results of the study, the researchers promised to inform them of the results of the

research.

Chapter 4

Results

This chapter discusses the findings from one hundred fifteen (115) questionnaires

completed by medical professionals who have experienced patient death under their care. The

purpose of this study is to address the issue of grief amongst medical professionals’ in response to

patient death and to examine the relationship of grief reactions with self-compassion, meaning-

making, and profession of medical professionals. In addition, it aims to find out which among the

variables will be the best predictor of grief reactions among medical professionals.

The researchers gathered all data needed from medical professionals in Pampanga and

Metro Manila. After gathering the quantitative data, the researchers successfully sent request

letters for participation to seventeen (17) hospitals in Pampanga wherein only four (4) hospitals

complied with the requests. The four (4) hospitals in Pampanga who allowed their employees to

participate were namely: Mexico Community Hospital, Lingap General Hospital in Arayat, Holy

Trinity General Hospital in Arayat, and Sacred Heart Medical Center in Angeles City. Aside from

gathering data from these institutions, the researchers also utilized an online survey to gather the

needed quantitative data to complete the sample quota (100 participants). The researchers’ data

gathering methods allowed the researchers to reach their sample quota and in effect, creating a

more reliable data sample and analysis for this research. Among these one hundred fifteen (115)

respondents, eleven (12) respondents were interviewed to gather the qualitative data that were used

to support the quantitative data. To fulfill this study’s objectives, the researchers subjected the

quantitative data gathered to various statistical procedures using the computer program, Statistical

Package for the Social Sciences (SPSS), while the qualitative data was analyzed using Thematic

Content Analysis. The results acquired during the data analyses are presented in this chapter.

Demographic Characteristics of Participants

For the quantitative part of the study, good enough sample sizes were obtained to conduct

meaningful tests of comparison across the different variables. A total of 115 participants – 54

nurses and 61 doctors- answered three scales. Demographic data were collected using a

questionnaire consisting of demographic variables including sex, age, location, profession, years

of experience, number of deaths encountered and specializations. Detailed data of the participants’

demographic characteristics are displayed in Tables 1 to 2 and illustrated in Figures 2 to 8.

Table 1

Demographic Characteristics of the Participants (N=115)

Demographic

Nurses

(n=54)

Doctors

(n=61)

Total

(n=115)

n

%

n

%

n

%

Sex

Male

Female

20

34

37.04

62.96

23

38

37.70

62.30

43

72

37.39

62.61

Age group

20-25

26-30

31-35

36-40

41-45

> 45

Undefined

15

20

7

1

6

--

5

27.78

37.04

12.96

1.85

11.11

--

9.26

12

26

11

3

6

3

--

19.67

42.62

18.03

4.92

9.84

4.92

--

27

46

18

4

12

3

5

23.48

40.00

15.65

3.48

10.43

2.61

4.35

Location

Pampanga

Metro Manila

41

13

75.93

24.07

10

51

16.39

83.61

51

64

44.35

55.65

As shown in Table 1, the respondents came from Pampanga (44.35%) and Metro Manila

(55.65%). The sample (N=115) comprises of 43 males (37.39%) and 72 females (62.61%). As for

the age distribution, the age of the participants obtained were from 20 to 64 (with a range of 44)

and most of the participants in this study were contained in the age group of 20-30 having a

cumulative percentage of 63.48% of the sample. There are respondents though who were classified

as undefined because they did not indicate their age.

Figure 2. Distribution of Participants based on Sex

Figure 2 shows the distribution of participants based on sex in the study. It shows that there

are more female participants over male participants. As shown in Figure 2, there is a huge

difference in number between the two genders. Hence, it can be assumed that gender factors may

affect the results of this study.

Figure 3. Age Distribution of Participants

Correspondingly, Figure 3 illustrates the age distribution of participants in the study. It can

be seen that most of the participants’ ages range from 20 to 64 years old. With this, the researchers

noted age differences as a factor that may affect the results of the study.

Figure 4. Distribution of Participants based on Location

Likewise, Figure 4 illustrates the municipality distribution of participants in the study based

on location. The study was completed by 51 respondents from Pampanga and 64 from Metro

Manila. Compared with the gender distribution shown in Figure 4, Figure 4 shows smaller

differences between each location in terms of participant distribution. This difference in number

of participants per location is due to respondent availability and response rate.

Table 2

Supplementary Demographic Information (N=115)

Demographic

Nurses

Doctors

Total

n

%

n

%

N

%

Profession

Nursing Professional

Clinical Clerk

Post-Graduate Intern

Physician

54

--

100

--

7

12

42

--

11.48

19.67

68.85

54

7

12

42

46.96

6.09

10.43

36.52

Years in profession

Less than a year

1 to 5 years

6 to 10 years

11 to 15 years

More than 15 years

Undefined

3

27

15

3

5.56

50.00

27.78

5.56

20

27

4

5

--

32.79

44.26

16.67

8.20

--

23

54

19

8

3

20.00

46.96

16.52

6.78

2.61

No. of Patient deaths

1-5

6-10

11-20

> 20

14

11

9

20

25.93

20.37

16.67

37.04

23

14

5

19

37.70

22.95

8.20

31.15

37

25

14

39

32.17

21.74

12.17

33.91

Specialization/Area of Unit

General Practice

Internal Medicine

Emergency Medicine

OB-Gynecology

Surgery

Pediatrics

41

1

9

1

--

75.93

1.85

16.67

1.85

--

46

7

1

2

3

75.41

11.48

1.64

3.28

4.92

87

8

10

3

4

3

75.65

6.96

8.70

2.61

3.48

2.61

The sample consisted of 61 doctors (53.04%) -- 7 clinical clerks, 12 post-graduate interns,

42 physicians, and 54 nurses (46.96%). As for their years of experience, the table shows that

majority of the participants, 54 nurses and doctors, in this study have been in their respective

professions within the range of one to five years. The table also shows that most of the participants

had either only one to five patient deaths (32.17%) or more than 20 patient deaths under their care

(33.91%). Lastly, Majority of the participants were in General Practice (75.65%).

Figure 5. Distribution of Participants based on Profession

Figure 5 shows the distribution of participants based on their profession. It shows that there

are more doctors over nurses. However, there is only a seven-participant difference between

doctors and nurses.

Figure 6. Distribution of Participants based on their Years of Experience

Figure 6 shows the distribution of participants based on the number of years they have been

in the medical profession. It can be seen that almost have of the participants have only 1 to 5 years

of experience.

Figure 7. Distribution of Participants based on Patient Deaths encountered

Likewise, Figure 7 illustrates the number of patient deaths these medical professionals have

encountered. Results show that most of the participants have experienced more than 20 patient

deaths. It can be seen though that the differences are not that far from one another therefore any

factors related to years of experience differences may not affect the results of the study.

Figure 8. Distribution of Participants based on Specialization or Area of Unit

Lastly, Figure 8 shows the specialization distribution of participants in the study. It can be

seen that most of the participants are in the general practice field. This larger difference between

each specialization or area of unit is probably caused by almost all nurses practicing general

practice, and the intern doctors not having a specialization yet.

Descriptive Statistics

Grief reactions, self-compassion, and meaning-making, the main variables in this research

were measured using the Hogan Grief Reaction Checklist, Self-Compassion Scale – Short Form,

and Grief Meaning and Reconstruction Inventory scales. Table 3 shows the descriptive statistics

of the scores of the participants in the different scale instruments used in this study.

Table 3

Descriptive Statistics of Hogan Grief Reaction Checklist, Self-Compassion Scale, and Grief and

Meaning Reconstruction Inventory Scale (N=115)

Scale Scores

M

Mdn

SD

Skewness

Kurtosis

Range

Min.

Max.

HGRC

1.897

1.730

0.715

1.075

0.693

1.00

4.16

SCS-SF

3.260

3.330

0.343

-0.449

-0.137

2.17

3.92

GMRI

3.401

3.390

0.399

-0.220

0.051

2.28

4.28

Table 3 shows the descriptive statistics of the scores of the participants in the different

scale instruments used in this study, in terms of mean, median, standard deviation, minimum score,

maximum score, skewness and kurtosis. As seen in this table, the scores for HGRC are positively

skewed, while the scores for SCS-SF and GMRI, although a bit negatively skewed, are relatively

still within the normal curve. The graphs for the distribution of scores in the Hogan Grief Reaction

Checklist, Self-Compassion Scale, and Grief Meaning and Reconstruction Inventory, are

presented in Figure 9, Figure 10, and Figure 11, respectively.

Figure 9. Histogram demonstrating the distribution of the scores in the Hogan Grief Reaction

Checklist (HGRC)

The Hogan Grief Reaction Checklist (HGRC) measures the participants’ severity of grief

reactions in response to a patient death. As seen in Figure 9, the HGRC scores of the participants

obtained a mean score of 1.897 (SD = 0.715). The minimum score of the participants was 1.00

while the maximum score obtained was 4.16. A low score in the HGRC indicates low severity of

grief reactions. It can be seen in the graph that 66.96% of the participants were either low or

average scores in the HGRC because their scores fall between 1.00 to 2.06. Thus, presenting a

graph that is positively skewed.

Figure 10. Histogram demonstrating the distribution of the scores in the Self-Compassion Scale –

Short Form (SCS-SF)

The Self-Compassion Scale (SCS-SF) which measures the participants’ compassion

towards oneself. The participants’ scores obtained a mean score of 3.26 (SD = 0.399). The

minimum score that the participants got was 2.17 while the maximum score was 3.92. Figure 10

shows that the scores are slightly negatively skewed. This indicates that majority of the

participants’ scores are slightly higher than the mean (M = 3.40).

Figure 11. Histogram demonstrating the distribution of the scores in the Grief Meaning and

Reconstruction Inventory (GMRI)

The Grief Meaning and Reconstruction Inventory was used to measure the participants’

level of meaning-making whenever a patient death is encountered. The GMRI scores obtained a

mean score of 3.401 (SD = 3.39). The minimum score was 2.28 and the maximum score was 4.28.

Figure 11 shows that the distribution of scores is relatively contained within the normal curve.

This figure also shows some hints of negative skewness as seen in the areas 2.50-3.00. The

researchers think that the reason for the low skewness value of these scores is due to the high

frequency of scores in the area of 3.40-3.60, as presented by the figure, which contains the value

of the mean of the total scores.

Table 4

Prevalence Rates and Scores of HGRC, SCS-SF, and GMRI Among Nurses and Doctors (N=115)

Scale

Nurses

n = 54

Doctors

n = 61

n

%

M

SD

n

%

M

SD

HGRC

Low

Average

High

15

19

20

27.8

35.2

37.0

16.70

53.91

84.33

9.27

9.38

10.27

21

20

34.4

32.8

15.76

43.93

81.46

9.44

8.71

10.65

SCS-SF

Low

Average

High

12

22

20

22.2

40.7

37.0

20.83

53.16

82.39

8.29

9.77

7.57

19

23

19

31.1

37.7

31.1

10.43

40.51

84.35

6.29

10.45

11.97

GMRI

Low

Average

High

16

21

17

29.6

38.9

31.5

16.41

51.37

84.50

9.44

9.94

9.66

23

18

20

37.7

39.5

32.8

18.07

51.23

84.22

10.25

9.84

9.23

Note: HGRC – Low, 1.30-32.61, Average, 34.35-66.52, High, 67.83-100

SCS-SF - Low, 0.87-30.43, Average, 36.09-64.78, High, 73.48-100

GMRI - Low, 0.87-36.08, Average, 37.83-65.22, High, 71.74-100

As shown in Table 4, the division for these responses was based on the percentile of the

scores of the total sample in each of the scales. For the HGRC, the percentile rank of 32.61 had

the score of 1.41 while the percentile rank of 67.83 had the score of 2.08. This means that the

scores from 1.00-1.41 are categorized as “low”, the scores from 1.45-2.08 are categorized as

“average”, and the scores from 2.08-4.16 are categorized as “high”.

Meanwhile, for the SCS-SF, the percentile rank of 30.43 had the score of 3.08 while the

percentile rank of 73.48 had the score of 3.50. This means that the scores from 2.28-3.22 are

categorized as “low”, the scores from 3.28-3.56 are categorized as “average”, and the scores from

3.50-4.00 are categorized as “high”.

Lastly, for GMRI, the percentile rank of 36.08 had the score of 3.08 while the percentile

rank of 71.74 had the score of 3.61. This also means that the scores from 2.28-3.22 are categorized

as “low”, the scores from 3.28-3.56 are categorized as “average”, and the scores from 3.61-4.28

are categorized as “high”. These categories were made to make further comparisons in terms of

profession. However, the descriptive statistics and data analysis used in this study are only derived

from the valid responses obtained (N=115).

Means and standard deviations separated by score category of the participants’ HGRC,

SCS-SF, and GMRI by group (nurses and doctors) are presented in Table 4. Mean scores on the

HGRC scale for nurses and doctors were 54.84 and 46.54, respectively, indicating average levels

of grief reaction severity among both groups. Both nurses and doctors had average levels of self-

compassion of 56.80 and 44.80, respectively. Moreover, the participants also showed average

levels of meaning-making with mean scores of 51.44 and 49.54, respectively. Whereas nurses and

doctors all scored average levels on the scales, compared with doctors, nurses had significantly

higher levels of self-compassion (p = .013).

Prevalence rates of grief reaction severity, self-compassion, and meaning-making (HGRC,

SCS-SF and GMRI) among nurses and doctors are also presented in Table 4. Approximately 70%

of nurses (n= 39) had average to high level scores in the HGRC, indicating average to high levels

of grief reaction severity in response to patient death while approximately 70% of doctors (n= 41)

had low to average level scores. Seventy eight percent (n= 42) and 70% (n= 38) of nurses had

average to high level scores in the SCS-SF and GMRI, respectively. In contrast, 68% (n= 42) and

77% (n= 41) of doctors had low to average levels of SCS-SF and GMRI, respectively.

Correlational Analyses

Upon running further analyses, the researchers have obtained information on how each of

the variables and demographic properties are related to each other. It was hypothesized that a

negative correlation exists between grief reactions and self-compassion, grief reactions and

meaning-making, while a positive correlation exists between self-compassion and meaning-

making. Also, the researcher aimed to find out which of the two variables – self-compassion and

meaning-making – is the best predictor of grief reactions. To test these hypotheses, the researcher

used different and appropriate statistical analyses.

Pearson r Correlational Analyses

To examine the relationships of the three variables, scores from the Hogan Grief Reaction

Checklist (HGRC), Self-Compassion Scale (SCS-SF), and Grief Meaning and Reconstruction

Inventory (GMRI) were analyzed using the Pearson product-moment correlation (Pearson’s r).

The correlations between the aforementioned variables are summarized in Table 4. An alpha level

of .01 was used for all the correlational tests across variables.

Table 5

Correlations for Scores on the Hogan Grief Inventory Checklist (HGRC), Self-Compassion Scale

(SCS-SF), and Grief Meaning and Reconstruction Inventory (GMRI)

Measure

HGRC

SCS-SF

GMRI

HGRC

1

-.279*

-.289**

SCS-SF

-.279**

1

.325**

GMRI

-.289**

.325**

1

** Correlation is significant at the 0.01 level (1-tailed).

As shown in Table 5, there is a significant negative correlation (r= -.279; p= .001) between

the scores from the SCS-SF and HGRC. Hence, the findings suggest that as self-compassion

increases, the grief reaction severity of the participants in this study decreases. On the other hand,

as the level of self-compassion decreases the grief reaction severity of the participants increases.

The results lend support to the researcher’s first hypothesis, which states that there is a significant

negative relationship between grief reactions and self-compassion. Thus, it can be inferred that the

more self-compassionate the participant is in this study, the less he or she is likely to experience

grief reactions in response to patient death.

Also, it can be seen in Table 5 that a significant negative correlation (r= -.289; p= .001)

exist between the GMRI scores and the HGRC scores. Similar with the results between the SCS-

SF scores and the HGRC scores, the results suggest that as the participants’ meaning-making

scores increases their grief reaction severity decreases. Conversely, as meaning-making decreases,

the acquired scores in the HGRC increases. It can be seen that the following results supported the

second hypothesis of the researcher, which states that there is a significant negative relationship

between meaning-making and grief reaction severity. Hence, it can be said that the higher the

meaning-making, the lower the severity of grief reactions in response to patient death.

Lastly, the researchers also hypothesized in this study that there is a significant positive

relationship between self-compassion and meaning-making. In the same way, the results shown in

Table 5 correspond to this hypothesis. It can be seen in Table 5 that a significant positive

correlation (r= .325; p< .001) exist between the SCS-SF scores and the GMRI scores. In other

words, as the SCS-SF scores increase, so does the GMRI scores and vice versa. Thus, it can be

deduced that more self-compassionate participants have better meaning-making compared to less

self-compassionate participants.

Figure 12. Scatterplot demonstrating the relationship between the scores on the Hogan Grief

Reaction Checklist (HGRC) and Self-Compassion Scale (SCS-SF)

The researchers detected a weak and negative correlation between the HGRC and SCS-SF

scores, r(115) = -.279, p= .001, with a r2= .078. Because high scores on the HGRC imply severe

grief reactions to patient death, the negative correlation between the HGRC and SCS-SF scores

indicates an increase in the grief reaction severity upon the decrease of self-compassion. This

supports the initially assumed negative correlation between the aforementioned variables. Also, a

variance estimate value of .078 shows that the Self-Compassion Scale scores account for 7.8% of

the relationship.

Figure 12. Scatterplot demonstrating the relationship between the scores on the Hogan Grief

Reaction Checklist (HGRC) and Grief Meaning and Reconstruction Inventory (GMRI)

Similarly, the researchers detected a weak and negative correlation between the HGRC and

GMRI scores, r(115) = -.279, p= .001, with a r2= .084. Because high scores on the HGRC imply

severe grief reactions to patient death, the negative correlation between the HGRC and GMRI

scores indicates an increase in the grief reaction severity upon the decrease in the level of meaning-

making. This also supports the initially assumed negative correlation between the aforementioned

variables. Also, a variance estimate value of .084 shows that the Grief and Meaning Reconstruction

Inventory scores account for 8.4 % of the relationship.

Figure 13. Scatterplot demonstrating the relationship between the scores on the Self-Compassion

Scale (SCS-SF) and Grief Meaning and Reconstruction Inventory (GMRI)

As hypothesized, the direction of the relationship between the Self-Compassion Scale

scores and Grief Meaning and Reconstruction Inventory scores was positive, r= .325, p< .001,

with a r2= .106. The findings suggest that as SCS-SF scale scores increases, the scores in the GMRI

also increases. This also means that a decrease in the scores of the SCS-SF will also lead to a

decrease in the GMRI. This finding supports the researchers’ hypothesis that self-compassion and

meaning-making have a positive significant relationship.

Point-Biserial Correlation Analysis

Additionally, although not included in the researchers’ proposal, a Point-Biserial

Correlation Analysis was conducted to determine the relationship between the Hogan Grief

Reaction Checklist Scores, Self-Compassion Scale scores and the Grief Meaning and

Reconstruction Inventory scores—continuous data—to Profession, a categorical data.

Table 6

Correlations of Scores on the Hogan Grief Inventory Checklist (HGRC), Self-Compassion Scale

(SCS-SF), and Grief Meaning and Reconstruction Inventory (GMRI) to Profession

HGRC

SCS-SF

GMRI

Profession (rpb)

.131

.210*

.040

P

.081

.012

.336

* p < 0.05

As seen on Table 6, only the correlation between the scores on SCS-SF and profession is

significant (r= .210; p< 0.05). Findings showed that there is no significant relationship between

severity of grief reactions, level of meaning-making and type of profession. Because of this, the

researchers decided to focus more on the direction of the relationships. To interpret the direction

of correlation, the researchers analyzed how the variable Profession was coded: 1= Doctor, 2=

Nurse. The analysis reflected a positive correlation between Hogan Grief Reaction Checklist

scores and Profession, r= .131, p= .081, with a r2= .017. A positive correlation was also observed

between Self-Compassion Scale scores and Profession, r= .210, p= .012, with a r2= .044. Likewise,

a positive correlation was found between the Grief Meaning and Reconstruction Inventory scores

and Profession, r= .040, p= .336, with a r2= .002.

Positive correlation means that there is a tendency for a respondent with a high value on

one variable to also have a high value on the other variable. Thus, the positive correlations between

profession and HGRC, SCS-SF, and GMRI scores mean that doctors (low value) is connected to

lower HGRC, SCS-SF, and GMRI scores and nurses (high value) are connected to higher HGRC,

SCS-SF, and GMRI scores. Therefore, results indicate that nurses tend to have higher self-

compassion than doctors. Although only one correlation turned out to be significant, the directions

of these correlations were as hypothesized.

Multiple Regression Analysis

A multiple regression analysis was calculated to check the extent to which each variable

and in combination can predict the severity of grief reactions in response to patient death of the

participants. This method was also used to determine which of the predictor variables will be the

better predictor of grief reactions because of patient deaths. Shown in Table 7 is the model

summary used to check how well the regression model fits the data available.

Table 7

Multiple Regression Model Summary

R

R2

Adjusted R2

Std. Error of the Estimate

.349a

.122

.106

.67579

a. Predictors: (Constant), Self-Compassion, Meaning-making

The column R indicates the multiple correlation coefficient which can measure the quality

of the prediction of the severity of grief reactions. As presented in Table 7, the model summary of

regression shows that the value of the multiple regression coefficient between the predictors (self-

compassion and meaning-making) is R= .349. This value indicates a good level of prediction. Also,

this value represents the strength of the relationship between the predictors and the outcome. The

coefficient of determination (R2) column, on the other hand, consists of the value .122 that means

self-compassion and meaning-making explain 12.2% of the variability of the severity of grief. In

other words, 12.2% of the total variance in the severity of grief reactions is accounted for self-

compassion and meaning-making. However, if the R2 will be adjusted, the results tell us that 10.6%

of the variance of the dependent variable is explained by the independent variables.

Table 8

Multiple Regression ANOVA a

SS

df

MS

F

Sig.

Regression

7.094

2

3.547

7.767

.001b

Residual

51.149

112

.457

Total

58.243

114

a. Dependent Variable: Grief Reactions

b. Predictors: (Constant), Self-Compassion, Meaning-making

Table 8 presents the ANOVA from the multiple regression analysis done. The F column

shows whether the regression model fits the data well. Results indicate that the independent

variables are statistically significant predictors of the dependent variable, F(2, 112) = 7.767, p=

.001, with an R2 of .122 and therefore confirms that the regression model is a good fit for the data.

Table 9

Multiple Regression Coefficients

Model

Unstandardized

Coefficients

Standardized

Coefficients

β

Std. Error

Beta

t

Sig.

(Constant)

4.653

.706

6.594

.000

SCS-SF

-.431

.195

-.207

-2.208

.029

GMRI

-.397

.168

-.222

-2.369

.020

Hogan Grief Reaction Checklist score was the criterion variable while the Self-Compassion

Scale score and Grief Meaning and Reconstruction Inventory score are the predictor variables.

Both variables were calculated to be significant predictors of grief reactions. It can be seen in Table

8 that self-compassion (M= 3.26, SD= 0.343) significantly predicts grief reactions, generating a

t-value of -2.208 (p < .05). This means that an increase on a participant’s level of self-compassion

amounts to a negative .207 change on his or her grief reactions’ severity. On the other hand, the

other predictor variable, meaning-making (M= 3.401, SD= 0.399), obtained a t-value of -2.369

(p< .05).

The same statistical test revealed that meaning-making is the better predictor of grief

reaction severity than self-compassion with β= -.397, p< .05. Self-compassion was also a

significant predictor of grief reactions with β= -.431, p< .05. This result is opposed to the seventh

hypothesis which states that self-compassion is the better predictor of grief reactions. The possible

reasons as to why it turned out like this will be discussed in the next chapter.

Additionally, as another ancillary data analysis, the researchers tried to analyze the

associations between demographic variables and HGRC, SCS-SF, and GMRI, and their findings

are shown in Table 10.

Table 10

P Values for the Associations Between Demographic Variables and Grief Reaction Severity,

Self-Compassion and Meaning-Making

Demographic Variable

HGRC

SCS-SF

GMRI

Number of Deaths Encountered

Years in Profession

Gender

Age

.055

.284

.438

.162

.253

.767

.423

.010*

.469

.076

.176

.109

* p < 0.05 a Significant relationship indicating that nurses having significantly higher SCS-SF compared

with DOCTORS

After analyzing the associations between HGRC, SCS-SF, and GMRI scores and the

demographic variables using univariate regression models. The only demographic variable that

showed an association with any of the variables is Age. Findings show that medical professionals’

age is associated with self-compassion levels. No significant associations were found between any

of the demographic variables and grief reaction severity and meaning-making.

Comparative Analysis

To determine whether there are differences on the scores on the scales based on profession,

the Mann-Whitney U test was used to compare differences between the HGRC scores for the

values obtained were not normally distributed while an independent samples t-test analysis was

conducted for SCS-SF and GMRI. The following results from the comparative analysis were based

on the assumption that the data generated from nurses and doctors on the measures used are interval

in nature and are normally distributed. Likewise, equal variances of the two groups are assumed.

Before presenting the results of the test of difference between males and females concerning the

three variables, descriptive statistics of each group on each scale will be discussed.

Table 11

Group Statistics on Hogan Grief Inventory Checklist (HGRC), Self-Compassion Scale (SCS-SF),

and Grief Meaning and Reconstruction Inventory (GMRI)

Measure

Nurses

Doctors

M

SD

M

SD

HGRC

1.9961a

.73194

1.8092b

.69340

SCS-SF

3.3361a

.26418

3.1923b

.38983

GMRI

3.4178a

.38333

3.3861b

.41533

Note. N = 115

an = 54, bn = 61

Table 11 includes the mean and the standard deviation of scores in the HGRC, SCS-SF,

and GMRI grouped according to profession. It can be observed that there is only a slight variation

in the average scores of nurses and doctors on all measures.

Table 12

Mann-Whitney U test for Hogan Grief Inventory Checklist (HGRC)

Scale

Profession

N

Mean Rank

Mann-Whitney

U

Z

p

HGRC

Doctors

Nurses

61

54

53.52

63.06

1373.5

-1.533

.063

The Mann-Whitney test was conducted to indicate which group can be considered as

having the greater severity of grief reactions. In this case, the group of Nursing Professionals had

the highest grief reaction scores. From the data in Table 12, it can be concluded that HGRC scores

of Nurses aren’t statistically significantly higher than the scores of Doctors (U= 1373.5, p= .063).

Table 13

Independent-Samples T-test for Hogan Grief Inventory Checklist (HGRC), Self-Compassion

Scale (SCS-SF), and Grief Meaning and Reconstruction Inventory (GMRI)

Measures

t

df

Sig.

(1-tailed)

Mean

Difference

95% Confidence Interval

Lower

Upper

SCS-SF

-2.285

113

.012

-.1438

-.2685

-.0192

GMRI

-.424

113

.337

-.0317

-.1800

.1166

The t-test revealed that contrary to what was hypothesized, only the scores of the

participants on one out of the two measures had a significant difference in terms of their profession.

No significant difference was found between the scores of doctors and the scores of nurses on the

Grief Meaning and Reconstruction Inventory (GMRI), t= -.424 with df= 113 (p= .337). These

results indicate that profession differences in the measure is not significant at an alpha level of .05.

Moreover, in the GMRI, the mean difference between the nurses’ scores (M= 3.418, SD= .3833)

and the doctors' scores (M= 3.386, SD= .4153) is -.0317. If GMRI will be conducted to a larger

population, it would yield a mean difference between -.1800 and .1166.

Meanwhile, Self-Compassion Scale (SCS-SF) scores showed a significant difference

between nurses and doctors with a t value of -2.285, with df of 113, and p value of .012, which

indicates that the profession differences in the measure is significant at an alpha level of .05. The

mean difference between nurses (M= 3.336, SD= .2642) and doctors (M= 3.192, SD= .3898) is

-.1438, indicating that administering the SCS-SF scale to a larger population would yield a mean

difference between -.2685 and .0192. This induces that doctors had statistically significantly higher

self-compassion compared to nurses t(113) = -2.285, p= .012.

Qualitative Analysis

Among the one hundred fifteen (115) participants, twelve (12) participants were selected

to be interviewed through purposive and convenience sampling. These twelve (12) responses were

divided into three categories based on their scores on the HGRC scale; high, average, and low.

Table 14

Distribution of Interview Participants based on HGRC Scale Scores (N=12)

Category

Nurses

Junior Interns

Senior Interns

Physicians

Low

--

4

Average

--

2

High

1

2

Note. Low, 1.30-32.61, Average, 34.35-66.52, High, 67.83-100

The interviews were completed by 12 medical professionals: five high scorers, two average

scorers, and five low scorers. Interviews were conducted either personally or through phone. Nine

of the participants were medical practitioners, two were interns, and one was a nurse. Majority of

the interviewees have been in the profession for 1 to 5 years and most of these doctors and nurses

reported that they have encountered more than 20 patient deaths in their practice. Overall, eight

female and four male participants who ranged in age from 23 to 45 years, from the different cities

and municipalities of Metro Manila and Pampanga took part in the qualitative part of the study.

The following sections summarize the results gathered from the in-depth interviews. The

findings of this study are laid out in themes found within the interview of each participant. These

findings are organized within seven different sections that cover the different aspects of

understanding the relationships between self-compassion, meaning-making, and grief of medical

professionals who have experienced patient death. These aspects include their insights about their

work as medical professionals, reactions to patient death, factors that influence grief reactions,

impact of patient death on the personal and professional lives of medical professionals, patient

death coping strategies, role of self-compassion on patient death experiences, and lastly, role of

meaning-making on patient death experiences. Each section is further grouped into themes which

are derived from, the responses of the participants. Moreover, the direct quotations are provided

from various participants to further discuss each theme or domain. Abstracted themes from the

semi-structured interviews of twelve (12) participants are shown in Tables 15 to 21.

Table 15

Medical Professionals’ Insights about their Profession

Theme

Frequency

Perception of self as a medical professional

Able to help

6

Able to fulfill their duty

4

Learning

3

Best aspects of being a medical professional

Relieving patients of their illness

10

Receiving gratitude

6

Earning respect from society

3

Getting to know patients

3

Difficult aspects of being a medical professional

Lack of personal time

5

Poor healthcare system

4

Sympathizing with the bereaved

3

Experiencing patient death

3

Risk for burnout

2

To be able to draw some sense on how the participants respond to their patients, the

researchers asked how they perceive themselves as medical professionals and asked for insights

about their profession. The themes found from the responses are categorized under their self-

concept as a medical professional, the best aspects of being a medical professional, and the difficult

aspects of being a medical professional.

For the perception of self, several themes have been identified based on the descriptions of

themselves as medical professionals of the participants. Half of the participants perceive

themselves as someone who is “able to help” or “able to make a difference”. This was elaborated

by P8 (35, Low) this doctor stated, “I see myself as someone who is able to help a lot or people, to

treat them, relieve them of their pain and pati na rin try to prevent my patients from getting sick.”.

Similarly, P14 (41, Low) responded to this question with the words, “I perceive myself as someone

who’s able to help people and that makes me feel good. I get to make a difference.”.

These participants who described themselves medical professionals who help people have

this purpose among themselves and that is to treat their patients. Like what P10 (26, High) said,

“Helping others who are in need is actually a privilege. Yung makatulong sa iba na magprovide

ng medical assistance in any way”. P19 (28, Average) sees as someone who is able to make a

difference by doing all she can to save her patients. She shared her thoughts through an analogy

saying, “In a way kunwari ang teacher is ang ano niya is magturo, to help individuals to be

successful in life. Ako naman, it’s my job to do what I can with my patients.”

The theme about being able to fulfill their duties as medical professionals was also

abstracted from the interviews. P17 (47, Low) stated that he sees himself being a doctor as long as

he can serve and views himself as someone who is a medical professional because of a genuine

purpose. He said that, “as long as my health permits… Ano kasi yung doctor eh, vocation ‘yan eh,

di ka naman yayaman diyan sa pag-dodoctor.”. Also, P32 (45, Low) responded quite similarly,

she said that she sees herself as someone who is able to fulfill her duties as a doctor, “yung

perception ko sa sarili ko, parang very sympathetic, empathetic sa patients ko, minsan kahit

natutulog pa ako, tapos iisipin ko, kamusta na sila yung ganon…Gusto ko lang kase talagang

manggamot eh, gusto ko yung ginagawa ko.”

Another theme presented by the interviewees is seeing themselves as medical professionals

who are continuously learning. P37 (28, High) explained, “I think, as a doctor, I’m someone who’s

got a lot to learn, still. And, I know I still have a long way to go. I’m someone who’s thirsty for

knowledge, and I’m not really afraid to ask questions.”. P112 (24, High) also talked about how

being hardworking can be important as a medical professional. She stated,“I see myself as

hardworking, sensitive to other people’s needs, and resilient din kasi kapag meron akong

masamang feedback na napapansin ng mga teachers ko, ayun lang naman… so for anything,

hardwork is the cornerstone of being a good doctor.” Moreover, P1 (24, High), a clinical clerk

who hasn’t been in the medical profession for a long time yet, shared how uncertain she still is on

how she perceives herself as a medical professional. She explained, “Medyo hindi pa ako

sure…kahit ilang months na kami into this we’re still getting the hang of things…napapaisip ako

minsan na ganito ba talaga ginagawa ng mga doctors.”

In the medical field, just like in any other industry or profession, we expect that there are

positive and negative aspects that come with it. The researchers asked the participants to enumerate

the best aspects of being in the medical field. Their responses include saving patients, receiving

gratitude from them and their relatives, earning respect from society, and getting to know patients.

Majority of the participants identified being able to treat their patients, to save and relieve

them of their pain and illnesses is one of the best aspects. As what P19 (28, Average) shared, “It’s

very rewarding if you do your job well, so ganun, parang, uhm, you save, you address the problem

and then you prevent them from having complications and then when you get to send them home,

that’s very fulfilling.” P8 (35, Low) also answered that the best aspect for him is, “Kapag nattreat

ko yung patients ko, seeing them okay again after treatment”.

P19 (28, High) also shares the same sentiments she said that the best aspect of being a

doctor is she gets to save patients. She said, “you save, you address the problem and then you

prevent them from having complications and then when you get to send them home, that’s very

fulfilling.”

Another one of the best aspects the participants identified was receiving gratitude from the

patients. Some participants expressed that it is very rewarding for them to hear their patients or

their patients’ relatives give them kind words of gratitude. Simple words like “Thank you, doc.”

and “Thank you for saving my mom.”. P17 (41, Low) also explained that one of the best aspects

is, “Fulfillment ng mga salita, yung fulfillment kapag sasabihin ng mga pasyente sayo na ‘Doc,

thank you po. Okay na po yung pakiramdam ko.’”

Another positive aspect of being a medical professional is earning the respect of the society

and empowering people who aspire to be medical professionals too. P32 (45, Low) summed up

the idea of this them as she said:

“Tapos, let’s be honest, sa Philippine society kase, yung mga postgraduate courses like

abogacia (law) diba? Medisina, yung society parang, yung respect nila dun sa mga ganon,

diba? … Pero sometimes when you go outside medyo conscious ka kase these people look

up to you. Tapos isa pa yung gusto ko dyan, yung parang, now that they see me like this,

naiinspire ko yung ibang tao”

P47 (30, Average) said, “It’s actually more of a being able to reach out to people, and how

they see you in a different light, parang they see you in a regarded person in the society” in

describing one of her favorite aspects of being in the medical profession.

There were also participants who shared that connecting and interacting with their patients

are one of the best aspects. To explain why this was her favorite aspect, P1 (24, High) stated…

“Favorite aspect ko is being able to get to know the patients, like kasi sa PGH, Malaki

yung volume ng patients and yung variety ng mga sakit nila, marami talaga. But more than

that, very interesting malaman yung history nila, yung bakit sila nagkaganon, yung context,

like for example siguro yung part ng culture, socioeconomic status, and lalo na, yung

personality nila that’s the part I look forward to getting to know the most.”

P47 (30, Average) also explained how important it is to her to connect with her patients,

she said, “I really try to spend time talking to the patients, as much as possible I try to treat them

not just as cases, but more of as people. So, I really spend time with them, to talk to them, to

counsel them, kung ano man yung naffeel nila and kung kamusta sila…”.

Just as there are two sides to every story, being a medical professional has its best and most

difficult aspects. For the most difficult aspects, themes abstracted range from not having enough

personal time, our country having a poor healthcare system, experiencing the inevitability of

patient death, feeling the need to sympathize with the bereaved to the feeling of burnout.

Most of the interviewees shared that, in this profession, you hardly get to have time for

yourself or time to spend with your family. P37 (28, High) explained this by,

“For me the most difficult aspect would be being away from your family, from your loved

ones. Kasi I don’t know if you know, but we doctors go on duty…2 days na may

duty…you’re really tired and most of the time you don’t really get to spend quality time

with your family tapos the next day hospital ka na ulit…Sometimes, you really have to

prioritize the hospital and your patients instead of your family and friends. It’s really a

great sacrifice on your part being able to work in the hospital setting. So it’s really giving

yourself to others than yourself.”

There are also other participants who go through the same routine and this just shows that being

in the medical profession, especially if you’re still in training, means you don’t get the luxury of

having most of your time for yourself or for your family. P17 (41, Low), an anesthesiologist also

shared that since they are on-call, even at the most unexpected times they can get called to the

hospital,

“Sa profession namin, sa specialty namin, wala kang oras. We’re called. We’re on-call 24

hours. Natutulog ka with your family bigla kang tatawagan, may bakasyon ka.. Although

pwede mo siyang ano, minsan nasa mall kami, tatawag sila, kailangan mong puntahan

diba?”

Other participants described lack of personal time, as the aspect of having her professional

responsibilities having to suffer consequences. P32 (45, Low) said, “Lalo na of course yung time,

time talaga, minsan sa sobrang busy wala na akong time for my family, lalo na sa anak ko.

Sometimes hindi ko rin natitignan lahat ng patients, kasi as a person may limits ka rin.” Her

response explains how important it is to have work-life balance.

Another difficult aspect of being a medical professional is having a poor healthcare system

such as the one in our country. P28 (33, Low) explained this as “Parang yung burden ng

kakulangan ng hospital, ng health system, napupunta sa doctor”, telling us that, because of this

problem, the doctors couldn’t give their full potential to the patients and are just forced to make

use of what is given to them even if it’s insufficient. P112 (24, High) also shared her firsthand

experience of how bad the healthcare system is, through working in a public hospital, “Maraming

hindi nakakapag-afford, hindi din nakakatulong na malaki gagamiting pera sa healthcare kasi

lahat, halos lahat self-pocketing spending.” Lastly, through P1 (24, High), most of the responses

of other interviewees are in line with her answer, “I think it’s the health system we have here sa

Philippines, sobrang wala, we deserve more, the patients deserve more.”

The next two themes that recurred are somewhat related to each other, experiencing patient

death and sympathizing with the bereaved family. For some of the participants, having their patient

die under their care was one of the most difficult aspects of being a doctor. As medical

professionals, they are aware that death is a natural event in the medical field, but it doesn’t mean

that they are immune to being affected by it. There are actually medical professionals who don’t

get to cope with what happens in the field and regard death as something they don’t want to

experience again.

Like what P1 (24, High) said, “Uhm yung namamatayan. Yun yung most difficult aspect

besides the obvious na you can’t save everyone…I don’t like losing patients to death. Parang

napaisip ako na, ayoko ng specialty na may namamatay.”. Another factor that makes losing

patients difficult is when you know that there isn’t anything you can do about it. Like what P8 (35,

Low) shared,

“Siguro is yung kapag namamatay rin yung patient, pero mas mahirap para sa akin kapag

alam ko na hopeless na kumbaga. Kasi minsan mahirap kapag yung family is hoping pa

na magiging okay, pero ikaw sa nakikita mo wala na. It’s hard to make them understand

na wala na talaga.”

P112 (24, High) also shared this statement: “Like, marami nakong naging patients na

namatay sa clear ko, bata, matanda, babae dito, lalaki dito, madami. Tapos pagka sunud-sunod

siya, syempre, hindi mo nakokontrol yung emotion debt.” She explained that having experienced

death for a number of times can cause consequences.

In line with experiences of patient death, the participants labeled having to deal with the

patient’s bereaved family as one of the most difficult aspects. This theme can be explained more

with the response of P14 (41, Low) as he stated, “One that’s more difficult is feeling bad for the

people who are left behind. I don’t feel bad for them (those who died), because they’re at peace. I

feel bad for the people that are left behind.”. Similarly, P61 (23, High) shared her experience in

palliative care department in the hospital in dealing with her sympathy to the bereaved, “Most

difficult aspect samin is when the family is getting attached to you tapos you get attached to them.

… That’s the time we provide comfort to those dying, ganun so we just treat yung pakikipag deal

with the family and not only with the patient.”

Lastly, with all the other difficult aspects mentioned, being in the medical profession makes

one more subject to burnout. P19 (28, Average) shared how they hardly have time for themselves

because of their work schedule, not to mention the work load as well. She explained,

“Being a doctor, in my own coverage, I come in at 7 when I am on duty, then I go home

mga 5am the next day. Pero yun yung normal ko. And then the following day, I have to

come in at 7 in the morning hanggang 5pm the same day. And I have to work every ano…

just like that for the whole year. I don’t get off. Wala akong, di kasama yung holidays, so

eventually burned out ka. And parang maiisip mo how can you function 36 hours straight

if tuloy-tuloy lang talaga.”

Meanwhile, for one participant, a major contributing factor for his risk of being burned out

is the poor healthcare system we have, P28 (33, Low) said that because our country doesn’t

prioritize healthcare, “nasasagad ang mga doctor, parang yung burden ng kakulangan ng hospital,

ng health system, napupunta sa doctor…alam mo hindi equal yung ano natin, in terms of financial,

yung income. Hindi equal. Yung part mo, over-worked ka, pero underpaid ka”. While this

participant did not describe himself as being “burned out”, through his response there was a notable

concern with developing symptoms of burnout.

Table 16

Grief Reactions to Patient Death

Theme

Frequency

Sadness

10

Crying

8

Acceptance

7

Guilt

6

Rumination

4

Disbelief

3

Through the interviews, the researchers were able to find out how medical professionals

react to patient death. The participants described a range of reactions to and expressions of grief

in response to patient death. These emotional experiences and grief reactions included sadness,

crying, acceptance, rumination, feeling of guilt among themselves, and disbelief. There were

participants who reacted negatively and there were also some who reacted positively.

For this part of the study, the researchers asked how the participants felt during and after

they encountered patient death. Majority of the participants described a feeling of sadness, as an

initial response to the death of their patient. P32 (45, Low) reminisced a particular patient death

experience, and when the researchers asked what she felt, she said “Ang lungkot ko kase parang

as a doctor, you can only do so much alam mo umiyak ako, tapos talagang ang lungkot lungkot

ko…”. P28 (33, Low) also talked about having feelings of sadness, “Actually…malungkot. Para

sakin syempre malungkot kasi parang feeling mo kulang yung naibigay mong tulong and alaga as

a doctor. Malungkot pero hindi ko naman talaga siya dala buong araw o buong linggo.”

There were medical professionals who responded to the experience by crying. P1 (24,

High) recalled the first time she had experienced patient death and shared that, “…as in umiyak

talaga ako nang sobra sobra and then humagulgol talaga ako.”. P19 (28, Average) who described

her situation then said that,“at that time, nung parang iiyak nako parang I had to excuse myself

from the family, so I did then umiyak ako sa restroom.” P37 (28, High) also had the same reaction

but mostly because he felt like he was able to give the patient the treatment she needed yet she

died, “...I cried about it, kasi nga, I know I was doing well with what was I supposed to do.”. As

mentioned earlier, most of the participants have felt sad but not all of them dwelled on this feeling

of sadness but rather reacted differently after quite some time.

There were medical professionals who also described having had feelings of acceptance or

contentment. Some have taken the experience quite well and were unregretful. As an example, P14

(41, Low) expressed his emotions toward death of his patient with relief, stating that,

“At first, of course I felt sad because it’s a small child…. but I felt relieved because hindi

na siya mag-ssuffer, he’s not gonna suffer anymore. In the end rin naman, he’s not gonna

get any better. So, he’s just basically living his last days of his life suffering with all these

tubes inserted into him.”

P8 (35, Low) and P17 (41, Low) and shared that they have accepted the unfortunate death

of their patient easily because they know that they have done what they can. P8 (35, Low) said, “I

know I did my best so there’s no regret in my part.”. P17 (41, Low) shared that he felt regret at

first for he thought that, “Sayang yung life. Hippocratic oath namin (is) to extend life...kaya lang

ayun di naman maiiwasan. Pero kung ginawa mo naman lahat, wala okay lang.”.

On the other hand, despite death being something usually beyond a person, even a doctor’s

control there were doctors who described feelings of guilt, self-questioning, and helplessness when

their patients died. P1 (24, High) expressed how guilty she felt when her patient died,“I felt guilt

talaga non, kahit nirereassure ako ng blockmates ko na there are some deaths na unexpected

talaga pero kahit ganon hindi matanggal yung sense of guilt, kasi feeling ko talaga I could’ve done

more.”. Similarly, P10 (26, High) who also felt guilt towards her patient’s death explained, “Yung

guilt sa part namin kasi parang...hindi naman siya yung expected na mangyayari at tsaka pwede

ma-prevent yung cause nung sudden shock nung patient. Kaya para samin, parang we couldn’t

help but to ask ourselves if may pagkukulang ba kami?”. As seen in the previous examples, related

to feelings of guilt is a sense of self-questioning that made some worry if they have missed

something that may have prevented the patient’s death.

Also, there were some participants who had reactions of rumination. After the patient’s

death, P14 (41, Low) who said, “I thought about it every now and then. Actually, I still do. Every

time I look at a kid, every time I look at my own kid, I think about that.” Some participants thought

about the patient who died every now and then, and even felt scared that she’d have to go through

another same experience. P37 (28, High) shared, “There are times na gusto kong lumabas sa

hospital kasi nga naalala ko yung mga, yung nangyari. And, parang medyo natakot din ako kasi I

don’t want to go through that again. But I know naman, eventually there could be a time na

mangyayari ulit yung ganoon.”. Similarly, P28 (33, Low) also had times when she thought of and

remembered the patient who died “Siguro may day lang kasi sanay ka yung pasyente nandoon,

aalagaan mo. Tapos babalik ka, makikita mo wala na siya. And alam mo kung ano yung

kinahantungan niya, alam mong hindi siya nakauwi ng masaya, ng buhay”

A sense of disbelief was also experienced by some of the participants. These medical

professionals are those who had patients that died unexpectedly. P61 (23, High) described what

she felt then like, “Sobrang blank lang, parang di siya nagsisink in sakin, yung level of

grievances.”. P37 (28, High) also initially felt disbelief and actually took quite some to before he

got over it. According to him, “I didn’t really know how to process it. I was really in shock and I

had a really difficult time processing it.”

Table 17

Factors that Influence Grief Reactions

Theme

Frequency

Patient-related factors

Patient age

7

Close relationship with patient

5

Identification with patient

2

Family-related factors

Emotional reactions of relatives

6

Dealing with bereaved family

7

Close relationship with patient’s family

3

Disease-related factors

Sudden and unexpected death

7

‘Bad’ Death

6

Table 17 shows the other factors that influence the grief reactions of medical professionals

to patient death. The participants noted factors that made some patient deaths more difficult than

others and thus influenced the severity of grief reactions they experienced. The themes that

emerged, were grouped into three categories, which includes patient-related factors, family-related

factors, and disease-related factors. Patient-related factors that made the loss particularly difficult

for the medical professional included young patients. Most of the participants responded that they

are more likely to feel severe grief reactions when the patient died at a young age. P14 (41, Low)

explained,

“Most difficult for me is this pediatric patient, a 4-year-old kid… Pero actually, ganon lagi

ako kapag pediatric patients eh. It’s always difficult for me kasi they never experienced life

yet, they’re so innocent, like they haven’t lived their life? And they already lost their life.

It’s different from losing a 90-year-old patient who lived their life already.”

P32 (45, Low) shares the same sentiments, she also identified age as a factor that heavily

influences grief. She stated that, “The older the pediatric patient, the harder it is. Gaya nga ng

sabi ko sayo, if it’s a premature baby, wala pa kasing deep relationship yan eh, pero pag 1 year

old, 2 years old, 14 years old, 7 years old… masakit yan.” However, being young doesn’t mean

that the patient has to be a child, P47 (30, Average) said most difficult experience was because --

“mas bata sya, male sya na nasa parang 30s or 40s palang. So siguro for me kase, yun yung

parang feeling ko kase it’s a waste of life? Na bata palang namatay na siya.” and P37 (28, High)

shared that his most remarkable patient was a girl not older than 18-years old who passed away

under his care, “I guess that was one of the most remarkable patient kasi bata pa lang siya and

she had a lot of potential. Alam naman nating bata yan, may potential to fulfill yung dreams niya

tapos biglang naputol diba just because of that medical condition niya.”.

Aside from young age, another patient-related factor is having a close relationship with the

patient. This includes patients they had treated over a long time period, or patients who they

generally felt a sense of closeness. One of the participants, P1 (24, High) said, “Yung biggest factor

for me na naka-influence is yung pagiging pinakamalapit ko sa kanya (patient). Sobrang bait kasi

niya, sobrang sweet sa akin, medyo kabado siyang tao kaya nirereassure ko siya. So ayun okay

talaga yung rapport namin.” Additionally, P19 (28, Average) also stated,

“I had a patient na 4 months siyang under my care. She was my patient for 4 months. She

had cancer. Siyempre, as she was a cancer patient, like expected naman na darating ang

time na mamatay din talaga siya. Pero again dahil 4 months ko siyang naging

pasyente…we got attached, and then, especially if the patient is very nice, and bata pa so

parang sayang yung buhay.. Pero ayun kahit expected mong mamamatay siya, dahil you

believe na you have grown attached to the person masakit padin na namatay siya.”

Also, results show that patients who the medical professionals identified with were harder

to deal with when they died. Identification in a sense that the patient reminded them of a family

member. As P14 (41, Low) has stated, “I remember this death the most kasi….it affected me. I was

able to relate to them because I too only have one child...I can’t imagine going through something

like that.”. Similarly, P32 (45, Low) talked about having thought of her only child when she had a

patient, who was also an only child, who died, she said “Ang sakit kasi it could have been my child.

Alam mo yun? Kasi magulang ka eh, pag inisip mo ang sakit sakit. At that time naiisip ko yung

anak ko, because it could happen to my daughter.”

Next, medical professionals also named several family-related factors that made patient

death more difficult. For the first theme under this category, most of the participants have stated

their experiences of dealing with the patient’s bereaved family. An example would be a statement

from P37 (28, High) he shared,

“…I was actually with the patient for more than 24 hours straight kasi na sa bedside lang

ako niya. So alam ko yung, how the mother was grieving, tapos yung hirap na

nararamdaman ng patient during the time, during the dialysis. Kita ko talaga yung hirap

niya. Sobrang hirap niya and I had a really difficult time processing it kasi she was really

close na napalapit na ko sa kanya you know during that short time.”

One more example would be from P61 (23, High), she also shared that it made it difficult

for her to deal with the parents of pediatric patients who start becoming unresponsive to palliative

care, “Ang hirap kapag ganon kasi, yung family na yung kailangan intindihin hindi na yung patient

kapag nagiging weak na. Ang hirap kapag ganon na yung case pero yung family fighting parin.

Yun yung pinakamahirap is pano mo iddeal and pano mo sila iseset sa reality.”

Another factor that we got from the participants’ responses is seeing the emotional

reactions of the patients’ families to death, P10 (26, High), stated that while they were trying to

resuscitate the patient, the patient’s son was there but the son wasn’t crying at all. She narrated,

“Noong wala na talaga, lumapit yung anak, tapos sabi ng anak sa tatay niya “okay na, sumama

ka na kay mama. Wag mo na kami problemahin”…so what struck me is inisip muna niya yung

tatay. Lalaki yung anak, emotions niya parang bottled up.” P19 (28, Average) also said that it

made it difficult for her to see the patient’s family after the patient died, “seeing yung parents and

relatives pa nung patients adds to the parang pain nung nangyayari so uhm as a doctor na hindi

dapat ipakita sakanila na affected ka, I had to excuse myself from the family the umiyak ako sa

restroom.” P47 (30, Average) shared the same sentiments, “mas nakakalungkot na nakita ko yung

family niya biglang pinapasok sa ICU tas nakita nila na nawala yung family member nila, kaya

dun yung mas emotional for me na seeing his family members na di nila matanggap na nawala na

yung family member nila.”.

Another is having close relationships with the patients’ families, P32 (45, Low) a pediatric

physician said that one factor that made a death more difficult is knowing the patient’s family too.

As she stated, “sa pedia kase syempre kasama lagi yung parents eh, ang hirap kasi makikita mo

na kung ano man yung pain ng anak nila, parang ramdam mo nararamdaman rin nila…hindi lang

yung mismong child yung nakakainteract mo pati rin ang parent.” P61 (23, High), who works in

the critical care department also said that she gets to have close relationships with not just the

patient but also the patient’s relatives.

“Most difficult aspect samin is when the family is getting attached to you tapos you get

attached to them…almost lahat sila kasi for palliative service na ganun…so minsan within

months nakikita mo sila everyday tapos maaattach ka sa family, iinvite ka nila to dinner

tapos they encourage you sa care ng patient. And pati yung mga problem with the family

nag oopen up na sila sayo. So that’s very difficult for us.”

Another notable factor but wasn’t included in the table was physician blame. P32 (45, Low)

had an experience of the patient’s family blaming her for what happened to their grandchild.

“ang masakit sakin dun is parang, hindi ko kagustuhan, pero they’re blaming me for

something na hindi ko rin gustong mangyari, sinabi nila na “E me pintalan ing apu ku

kaya mete ya” (Hindi mo pinuntahan ang apo ko kaya namatay siya). These people are

blaming me, well in fact I did everything I can...”

Lastly, for disease-related factors, sudden or unexpected patient death was reported as a

factor that exacerbated grief over patient death. On this, one participant said, that the most difficult

patient death she experienced was unexpected. P1 (24, High) described the situation she was in as,

“Sobrang biglaan talaga…on that day nagiging hypotensive yung patient, nagiging

unstable yung patient so icheck ko daw in a few minutes. But on that same day, it so

happens to be the same day that I had to present a report ...so yun naiiyak na ako, I had to

call the interns to cover for me para maalagaan siya...in the middle of my report, tinext

ako ng intern sabi, nag-’mort’ yung patient ko.”

P37 (High) who also experienced having his patient die unexpectedly said, “during the

part of my duty, ok naman siya kasi I was doing dialysis on the patient, so ok naman siya during

my 24-hour duty. And then bigla na lang talaga the next day, I found out na lang na she passed

away.” According to him, he was devastated after because he thought he was able to administer

the proper care based on the instructions of the senior resident.

Finally, the theme extracted came from the participants’ stories of patients who had a “bad

death” (i.e., painful death, inevitable death) or patients who appeared to be suffering. P17 (41,

Low) recalled his patient who died of Dengue,

“Kahit gaanong medical intervention, kahit anong tawag, di siya nagrerespond, blood

transfusion, experimental drugs from abroad, wala so binalik na sa hospital dito. While

she was at the NICU, she died na parang tinurn-off na light. Lahat ng medical don, yung

mga doctors don nagtatatanong, “Anong nangyari?” Tapos revive, revive, di na siya na-

revive talaga.”

Another medical practitioner, P47 (30, Average) told a similar scenario of having a patient who

had a bad death,

“this is a case in the ICU. So, in this hospital kase yung sa ICU...laging puno. So, some

patients, kahit na they have to be transferred to the ICU, they’re just waiting for a room,

they’re just in the ER. So when this finally got intubated sa ICU, maya-maya nagcode

kame, we ran the code for siguro about 30 minutes? Tapos narevive… and then after 30

minutes ulit, after ilang minutes ulit, nagcode siya ulit… And then I remember this one

parang when we were trying to revive him ulit… there was blood coming out of his mouth

na, so parang very gruesome na experience for me. Then wala na…”

One more example, is P14 (41, Low) experience of having a patient who had a family who still

desperately sought treatments for their child,

“They put the kid on life support, he was on life support for maybe a few weeks? After a

while, it was determined that there’s nothing more we can do to treat the child, basically

the child was just suffering on life support. But he wasn’t gonna get any better. So the

family decided to withdraw the care, to make him comfortable and to stop all the treatments

that we were doing.”

Table 18

Impact of Patient Death Experiences

Theme

Frequency

Personal impact

Emotionality

8

Desensitization

5

Compassion

3

Lowered self-esteem

3

Professional impact

Better work performance

7

Learning experience

7

Detachment from patients

6

Change in work motivation

5

Shown in table 18 are the collected themes about the impact of patient death experience to

the participants. The themes were categorized into two - personal and professional impact. Under

personal impact, the participants reported having changes in their emotional sensitivity,

compassion, and self-esteem. There were also some who had feelings of becoming desensitized.

While under professional impact, the researchers were able to abstract these themes from the

interviews –better work performance, learning experience, detachment from patients, and change

in work motivation.

On patient death’s personal impact, most of the participants have said that their

emotionality, one’s measure of a person’s emotional reactivity to a stimulus, was affected by the

patient death experience. P14 (41, Low) shared that his emotionality changed because of the

experience. He said, “I didn’t think that I was the sensitive type of person, but I seem to have gotten

affected.” Through his statement, emotionality has been described, by the participant, as his initial

response to the situation. Accepting your emotions keeps you grounded on your innate humane

characteristics. This proves that medical professionals aren’t exempted to feelings even though

they are trained to become composed throughout their patient death experiences. Other participants

shared this theme with a view on which they felt affected yet used this feeling as a tool for them

to be more emotionally prepared next time. P10 (26, High) said, “Parang it made more emotionally

prepared to handle to such things. Parang dati kasi di mo alam pano ittake in yung death in front

of you and yung reactions ng relatives but now parang with how I deal with it emotionally, mas

prepared na ako.”.

On contrary with the previous theme, there were medical professionals who grew

desensitized to death. Some have developed the ability to extinguish their emotional reactions

towards patient death after witnessing frequent patient death. As P17 (41, Low) explained,

“Alam mo pag, nung una, nakaka-ano ako ng death, yung una yung parang nung first, first

week ko sa hospital, siyempre pasyente ko e, e namatay siya, hmmm, pati ako umiiyak,

umiyak ako… Tapos bukas, may namatay nanaman, parang one week, araw-araw umiiyak

ako, nagsawa akong umiyak…nagsawa akong umiiyak. Araw-araw nalang umiiyak ako?”

On the same note, P61 (23, High) was also initially highly emotional because of her patient’s death,

she said “Emotionally it really affected me. Devastated ako, I was really depressed. Pero with the

following na mga deaths sa mga patients parang sometimes I feel na wala na, nasasanay na ako.”.

Another personal impact is, having more compassion, many of the participants shared that

the experience helped them gain more compassion for their patients. P14 (41, Low) said, “I’m

more compassionate (now). I’m more caring as opposed to, when I was younger. 20 years ago, I

wasn’t you know, I wasn’t as compassionate as I am now.” Like him, P19 (28, Average) also

shared how she became more compassionate towards her patients, she explained,

“(Yung patients) iba iba yung mga problems, iba iba yung pinagdadaanan, so as time goes

by parang naiintindihan mo na sila you learn to adapt kung ano yung kailangan nilang

maging ikaw..if you feel that your patient needs a strong doctor if the patient needs more

of your support maybe that would be the type of doctor you should be…Ayon so parang

based on my experience, parang kumbaga mararamdaman mo na sa mga pasyente mo

kung ano yung mas kailangan nila parang ganun…”

Correspondingly, there was also an impact to some of the participants’ self-esteem.

Although most of the participants understood rationally that they had done everything they could,

there were some who felt a sense of failure and this affected their confidence. P1 (24, High) said,

“Mababa na actually yung confidence (sa sarili) ko…but I guess bumaba pa lalo ng konti dahil

doon (patient death experience).” Similarly, P28 (33, Low) said, “Siguro may time na ganon

(bumaba confidence) lalo na kapag komplikado yung mga nakakasalamuha kong mga pasyente.

May times na I ask myself kaya ko ba ito? ... Baka magkamali ako, mamatayan ako (ulit).” Both

of these participants explained how their self-esteem as a medical professional lowered because of

how they failed to save their previous patient.

As mentioned earlier, medical professionals reported some impacts of patient death to their

professional lives as well. For professional impact, the researchers identified four themes from

how they were affected professionally. Mostly, the participants were affected in way that their

work performance improved. P28 (33, Low) shared that her patient death experiences helped her

become more careful when it comes to treating her patients, “Siguro mas maingat lang. Mas

naging, hindi naman istrikto yung term, ayun mas naging maingat lang ako sa hinahawakan ko.

Mas naging segurista na talaga yung tinitignan mo yung problema ng pasyente.” Similarly, P10

(26, High) also said, “With other patients, mas naging maingat kami. Hindi naman sa sinasabi ko

na hindi kami maingat dati pero kasi dati naooverlook. Yung kami ngayon parang pag may off

lang na konti sabihin kaagad sa residents”. These medical professionals discussed how they

wanted to provide better care and how each patient’s death taught them how to improve holistic

patient care in the future.

Another professional impact is that the participants took patient death as a learning

experience, these medical professionals shared how their patients’ death taught them how they

could learn from the experience, to learn from others, and try to find out how they can provide

better treatment for their future patients. P28 (33, Low) elaborated how the patient death became

a learning experience for her…

“From that experience kasi na namatayan ka, may natutunan ka. Nalalaman mo kung ano

yung mali mo, kung saan kayo nagkamali. So, hindi mo na siya uulitin. Malaking impact

yung namatayan ka, learning talaga yon. Kung saan ka dapat mas mag-iingat. Ano yung

mga babantayan mo mga ganung bagay…”

P32 (45, Low) shared how she was able to use her experience to improve as a doctor, she

said that, “For every death na ganon, kung careful kana, mas nagiging careful kapa…mas natututo

kapa so para sa next time, eto na yung gawin ko, hindi ganito, or iiwasan ko ito para hindi ganito

(ang mangyari). Kumbaga it’s a learning experience…”

On the theme about detachment from the patients, some participants expressed how their

attachment with their patients got affected after encountering a patient death. For P61 (23, High),

she now handles these types of experiences differently compared to how she does before, “Ngayon

mas manageable na professionally. Hindi ko na masyado iniinvolve yung emotions ko sakanila.

Kasi pag mas mabigat kasi siya pag ininvolve mo yung emotion mo sakanila and yung life mo.”.

P10 (26, High), who also talked about how important it is to know when you shouldn’t be attached

to your patient said that, “As a doctor, dapat meron kang sympathy sa patient but you have to

detach yourself, so you don’t get too emotionally attached to your patient kasi ikaw yung doctor

nila. You have to think as a doctor not as a relative.”. Like these two participants, there were also

some who recognized that if they get too emotionally attached, it would be hard for them to deal

with patient loss especially because things like this are most of the time out of one’s control.

Lastly, change in work motivation was also discussed as a professional impact of patient

death by the participants. Some participants got affected positively, while some were affected

negatively. P61 (23, High) shared that her motivation to go to work increased after, “syempre when

I see my patients na nahihirapan tapos parang nakikita ko na need nila ng care, I get motivated

naman. May times naman talaga na pumapasok ako hindi para sa sweldo or sa work kundi para

sa patients ko.” Similarly, P19 (28, Average) expressed that he was even more motivated after

experiencing patient death because he knows that his patients need him, he explained “mas lalong

motivated ako…kasi mas lalo kang kailangan e. yung mga doctors? kulang. mas lalo kang

kailangan. On the other hand, as mentioned earlier, there were participants who lost their

motivation for a period of time. As an example, P112, (24, High) said that there was a time when

she even felt scared of the thought that she might lose another patient, she further shared, “…ayun

naging less yung motivation ko na parang ayoko na. Super nakakapagod na, pero nagging okay

rin naman kasi within a day, marami rin naman akong natutulungan, may naissave rin kahit

paano”. Another participant who got affected negatively was P37 (28, High). When asked if his

motivation got affected by the patient death, he answered “Yes, definitely. There were days na I

didn’t want to go on duty, or I didn’t want to see patients that were a kin to me.” He described

how his motivation then got affected and even his relationship with his patients. However, like

P112, he was also able to move on from the experience and go back to the way he treats his patients

before. As P37 have described it…

“I eventually realized na, you need to get back with your patients. You need to develop

rapport with them to establish a good relationship with them in order to understand what

they’re going through. They’re not only seen as patients. They’re supposed to be seen as a

human being, as a whole person with many different aspects. So eventually, I stopped being

distant…I think I went back to my usual self na I became more engaged with the patients.”

Table 19

Existing Coping Strategies in Dealing with Patient Death

Theme

Frequency

Social support

10

Carrying on with work

5

Professional support

4

Turning to faith

3

Taking time off work

2

With aims of finding out what medical professionals find most helpful in terms of dealing

with patient death, the researchers asked the participants if they had particular coping strategies

that they do to manage patient death. Majority of the participants responded that they usually turn

to social support, which refers to the support one gets from family and friends. As P10 (26, High)

shared, “You have to have an outlet afterwards, from your colleagues, your relatives, your mother

or father ganun. Kasi if you don’t open up parang maaapektuhan din yung work mo.”

Also, although quite different from the others since she sought for people who are related

to the patient rather than someone whom she is close to, P19 (28, Average) coped with it by talking

about it with people or colleagues who also knew the patient, she said “I just talk to people about

it, yun yung pinaka helpful, I talk to the nurses, kasi yung mga pasyente ko, pasyente din nila uhmm

you just remember them like “oh naalala mo ba si ganitong patient, ganyan”.

Correspondingly, there are also some who seek for professional support from other

physicians or from colleagues to talk about their thoughts about the patient’s death, like what P32

(45, Low) did. She explained that, after the death he opened it up with a colleague and asked for

his expert opinion about what happened, “I called a neurologist…pag ganyan kasi you talk more

with your colleagues, I asked what could have been done, “may mali ba ko?”, tapos sinabi niya

kung ano yung objective, hanggang sa they would share their previous experiences as well”.

Moreover, although P14 (41, Low) didn’t undergo grief counseling himself, he mentioned that

their hospital provides grief counseling for their doctors and nurses, if they need to. Also, one

participant mentioned that most hospitals have conferences wherein different doctors discuss the

cases of patients who died. P17 (41, Low) sharing his experience said, “Mas makakatulong kung,

ishare mo yung ano, ahhh kami kasi ganito, mas ishare mo yung experience mo sa iba, kami kasi

sa hospital ganun, pag may namamatay…meron kaming conference para sa deaths ng mga

pasyente sa hospital.”

Another coping strategy that recurred was “carrying on with work”. Most of the

participants reported that they use work as coping to take their mind off it or because they simply

just have to. This theme actually had the second highest frequency count, a lot of doctors responded

that they usually just go back to work after a death of a patient. An example is the case of P28 (33,

Low), when asked what she did after to cope with the experience, she shared “Balik lang sa

duty...Parang ano kasi…isipin na lang yung ibang pasyente. Namatay siya so huwag mo ng

hayaan yung iba. Alagaan mo ng mas mabuti.”. Also, P14 (41, Low) who also just carries on with

work said that the reason why it helps him cope is,

“despite the losses we still get to save people. So even if we lose 10 people a month, we

also save a hundred people a month. So, if we go by statistics, were still good. I guess that

helps us in coping kase we lose some, but we save a bit more than we lose. I just think that

you can’t save everyone so you just have to do what you can.

Most of the participants mentioned that they turn to work as a coping mechanism because

they don’t want to grieve too much about the experiences, for they know that there are other

patients who need them and they don’t want their grief to get in the way of their work. As P10 (26,

High) have said,

“You have to move forward kasi we have other lives to save. We can’t save everyone. Yun

yun eh, we cannot save every one but we can save who we can. Parang kami sige one day,

iiinternalize namin kasi kailangan kami ng ibang tao. Pero of course every now and then,

may times rin na you’ll remember pero okay lang.”

Contrastingly, there were also participants who take time off work when they need to cope.

Through this most of them are enabled to pull themselves together and bring themselves to work

again. For example, in P112’s (24, High) case, she takes time off work to assess what happened.

Similarly, P61 (23, High) also took a break after a patient’s death to cope, she shared that…

“I isolated myself muna. Parang I dont know what to do kasi since I was so depressed until

na mag decide ako na to work again na I’ll try again. Medyo parang naging damaging

siya kasi over and over nakakaexperience ako ng death. Nakikita ko yung ano yung mga

patients ko namamatay, nakikita ko yung sarili ko sa other families.”

Lastly, one more theme that recurred was “turning to faith”. P32 (45, Low) said, “I pray,

nagp-pray ako syempre tapos tapos nabibigyan ako ng tibay ng loob gaya non… after my patient

died at the hospital, I went to a church nearby.”. Another example is from P17 (41, Low), he

shared, “In times na need ka nila diba, e kung doctor na yun na hindi nakapag cope up (tapos)

siya lang yung doctor sa barrio, edi wala ng titingin sa kanila (mga pasyente), you try to be strong

… prayers.”. With this statement he implied that deliberate communication with the spiritual being

you believe in could help in coping with the patient death experience.

Table 20

Role of Self-Compassion on handling Patient Deaths

Theme

Frequency

Cultivates mindfulness

10

Makes one compassionate towards others

9

Improves mental health and well-being

8

Helps in balancing detachment and empathy

5

In Table 20, shown are the themes that recurred from the responses of the participants on

what roles does self-compassion have on handling patient deaths and grief reactions. For this study,

the researchers further investigated the importance of self-compassion is on being a medical

professional. For participants who weren’t familiar with the term, the researchers defined self-

compassion as the ability to be compassionate to oneself in times of difficulty, failure, pain, and

personal shortcomings. When asked for further elaboration, self-compassion was also defined as

recognizing that suffering and personal failure is part of the shared human experience.

The most recurring theme abstracted from the narratives was “cultivates mindfulness”,

though the participants stated different ways of it being able to do so. There are many definitions

for mindfulness available on past studies, for this research, the researchers chose to define

mindfulness as Scott R Bishop and his colleagues did in the article, Mindfulness: A Proposed

Operational Definition (2004). Mindfulness means adopting a particular orientation toward one’s

experiences in the present moment, an orientation that is characterized by openness and

acceptance. For P37 (28, High), the importance of self-compassion as a cultivator of mindfulness

is that it helps you think clearly and gives you time to absorb what’s going on in your surroundings.

Moreover, he stated, “I think it’s being able to come up with a strategy and how to respond to

whatever occasion it may be as well. I think it’s more on taking time to think things through and

to really think of the way you react to different things and different people.”

On a similar note, P47 (30, Average) talked about how self-compassion helps you accept

the experience of having a patient die under your care. As she explained, “wala accept mo lang

rin naman talaga na…hindi lahat ng bagay under your control, and there are things na hindi mo

alam, so parang it helps you turn more into the positive side and look at the positive things in a

positive light. Another doctor, P10 (26, High), similarly explained,

As a doctor, you can only do so much. Hindi ka diyos, hindi mo kayang buhayin yung patay.

Parang you have to forgive yourself kasi you did your best. Kasi meron talagang time na

gawin mo lahat, you won’t be able to get a patient’s life back. So parang patawarin mo

sarili mo kasi ginawa mo naman lahat.

Another role that was identified through the participants’ descriptions is it “improves mental health

and well-being”. As explained by P28 (33, Low), having self-compassion is a way to take care of

yourself so you’ll be able to take care of others and give them the best treatment,

“alagaan mo yung sarili mo kasi sinong mag-aalaga sa iba kung ikaw mismo hindi

masigla? Hindi mo mahal…parang andami mong problema sa buhay. Maaapektuhan

talaga. Para siyang domino effect… Kaya importante talaga na yung doctor…yung doctor

mismo mindful sa sarili niya na healthy siya sa mind, body, spiritually.”

P37 (28, High) told a similar opinion, he also thought that it is important to look after

yourself. “As a person you also have your needs. And as a doctor, you know that you have a duty

to your patients. But it is also important to look after yourself. And if you don’t look after yourself

properly, it could affect to the way you work.”. Also, Clinical Clerk, P1 (24, High), said that her

self-compassion helps her know how or when to self-reflect. “Mahilig akong mag self-reflect. One

thing I learned in med school is that it’s important to choose myself. I like taking care of my mental

health, so I take time to reflect ganon. I take time for myself…”

The third theme as presented in Table 20 is the role of self-compassion as a tool that “makes

one compassionate towards others”. P14 (41, Low) explained, “it helps you learn how to relate,

like you’re in that position yourself. So, obviously you’re gonna try your best, or even go beyond

to try and see if you can make a difference.”. Another physician, P17 (41, Low) explained that

self-compassion is a must as a medical professional for it also helps one become sensitive to what

the patient and his or her family goes through. Specifically, he said,

“kailangan mong mafeel yung ano nararamdaman ng family niya ang approach ko kasi

diyan kunwari "anong nangyari? kausap ko palang kanina yan bakit siya namatay"…pag

ganyan kailangan sensitive ka feelings ng iba ang approach ko diyan ganyan "naiintidihan

ko po yang nararamdaman niyo" ganyan "meron po ba akong maiitutulong sainyo

magaling po akong makinig"…”

In relation to the last theme abstracted, “helps in balancing detachment and empathy”, P19

(28, Average) explained that as a doctor, you can’t get affected that much by patient deaths, she

stated, “hindi ka pwedeng affected or if affected ka man you, you shouldn’t show it, di ka dapat

nagpapakita sa mga pasyente mo na naaapektuhan ka you try to learn your emotions kase uhm

itong patient na to, again I handle 30 patients, kung mamatayan ako ng isa, yung the remaing 29

of my patients still need me.” P10 (26, High) also had similar thoughts, she also reiterated the

importance of not being too attached to patients and not giving into your emotions, “Mostly iniisip

ko yung welfare ng patient rather than my emotions. Empathy is good pero siguro konti lang. So

ang ginagawa ko is I try as much na wag masyado maging attached sa patient. I try to do my

responsibilities as a doctor…I try to be more on the professional side.”

Table 21

Role of Meaning-Making on handling Patient Death Experiences

Theme

Frequency

Improves work performance

9

Gives more value to life

7

Stimulates personal growth

6

Prevents severe grief reactions

4

For the role of meaning-making on handling patient deaths, several roles and meanings

made have been identified based on the responses of the participants. Aside from the importance

of meaning-making on handling patients, the researchers also asked how much sense they made

of the experience and what benefit did they get from it. As shown on Table 21, there were four

themes, namely improves work performance, gives more value to life, stimulates personal growth,

and prevents severe grief reactions. Through the interviews, it was found that meaning-making is

important to a medical professional in a way that it can affect him or her personally and

professionally.

Most of the participants responded that whenever they experience patient death, they take

it as an opportunity to improve themselves and provide better treatment to their patients. Some

share that the experience pushed them to improve their skills and change their work ethics. Some

also gave meaning to patient death as a learning experience that would make them aware of their

mistakes and the realities of being in the medical profession. P10 (26, High) shared how meaning-

making makes an impact to her work, she said that

“Kapag ganun it makes you more professional. Work ethics mo kasi. Mas nagiging

professional ka kasi iiwas ka sa burnout. Yun yung kalaban ng doctors when they’re

dealing with death day by day or more often than other doctors.”

Similarly, P28 (33, Low), elaborated on how the way she treats her patients changed, “Mas

naging maingat, mas naging … mas ma-scrutinize, mas matanong, binubusisi. Mas mabusisi ka

na doon sa (susunod na) pasyente. Parang ayaw mo na siyang, ayaw mong may malagpasan ka

na importante. Mas-maingat.”. P46 (30, Average) also talked about how she made sense of it as a

learning experience, she said that…

“I really take it as a learning experience kapag may case na “ay namatay siya because of

this” and I try to use it as an improvement, so you want to research more this type of

disease kase gusto mong ma-treat siya eh diba, so para sa next time makakita ka ng patient

na ganun, alam mo na kung anong gagawin mo, what to watch out for, so it’s more of you

take this bad experience and use it for something better, use it for improvement.”

Another thing that giving meaning to their experience of patient death taught most of these

medical professionals is to give more value to life. Through experiencing patient death, some

participants were able to appreciate life more and even realize how death is a part of life.

As mentioned earlier, the researchers asked how they made sense of the loss that they

encountered, P14 (41, Low) responded “I mean, you learn to look at life at a different perspective,

you learn to enjoy every minute, I mean life can be taken from you any minute, any second. You

learn to appreciate the little things more.” P19 (28, Average) also thought of it as a way to value

not just life but also her family relationships saying, “(Realizing) how short life is? How important

spending time with your loved ones more or kumbaga how fragile life is indeed.” P61 (23, High)

valued life in a way of dealing with death as a part of life you can’t control, also, saying,

“So ngayon yung reason behind it is di na ako masyado naghahanap through the course

of nature it really happens na talaga like everyone ends up dead naman. So usually, ganun,

darating tayo sa ganun, may nauuna lang. And then, sometimes bad yung experience nila

with death minsan naman comfortable naman sila in passing.”

Similarly, P112 (24, High) learned to accept death as well, she explained “Kasi kailangan

mong i-accept yung death as part of life in any age ganoon bata man or matanda, parang kahit

ano kasi talaga pwede mangyari.”.

Another theme that was abstracted from the responses is personal growth. Several forms

of personal growth were obtained from the participants. There were participants who became more

empathic, more compassionate, and more patient after giving meaning to their patient’s demise.

P46 (30, Average) said that being able to make sense of her patient’s death helped her progress as

an individual,

“I think it’s important (to make meaning of your experiences), it helps you gain empathy

and compassion, tapos most of the time rin patience. Important yun kasi tao rin sila, they

want to be served, they don’t want to be seen as just a patient, another case, or an object

… alam ng patient kapag the doctor is very compassionate about them or they have the

sense na they care for them.”

Also, another example is P8 (35, Low) said that, “this experience was just one of the things

that made me who and how I am today”. This directly explains how a patient death experience can

help someone grow as a person. There are some who also grew in a way that they were able to

realize that everyone has their own limitations. Like P32 (45, Low), she said that…

“Kahit na anong gawin mo, kung talagang ... yun na yun, it all goes down to… yun nga,

you can only do so much. Yun lang sa akin, parang yun yung meaning, yung sometimes

kailangan pumasok sa doctor yung humility to accept yung limitations niya na eto lang

yun, despite doing everything, kase wala, talagang yun lang yung gagawin mo.

Lastly, some participants held that making meaning of their patient death experiences

helped them prevent having severe grief reactions when time comes that they have to experience

patient death again. As P1 (24, High) explained, “I guess parang mas pinrepare niya (patient who

died) ako for other future mortalities that may happen. It helped me on what I can do possibly

prevent it.”. Furthermore, there were participants who made sense of their past experiences in a

way that it helped them learn how to take the situation well. P46 (30, Average) shared how she

deals with these kinds of experiences now compared to the way she did before …

“Ayun so firstly, it (patient death experience) made me stronger, kase parang unang una

kong makakakita ng ganun, very emotional ko, but then after a while I had to learn how to

cope with it, to not be so attached, cause if you get to attached it can lead into depression.”

Chapter 5

Discussion

The main purpose of the research was to address the issue of grief amongst medical

professionals’ in response to patient death and understand the relationship between their

profession, self-compassion, and meaning-making to their grief reactions. Also, one of its aims

was to tackle the profession differences that might exist in all the variables.

In the previous chapter, the results of the data gathering, and analyses were presented. The

researchers were able to gather information about the self-compassion, meaning-making, and grief

reactions of medical professionals who have experienced patient death. This research revolved

around the possible relationships of these variables with each other, including the profession

differences in every variable, was discussed. The researchers also specifically hypothesized that –

(1) self-compassion is negatively correlated with the severity of medical professionals’ grief

reactions in patient death; (2) meaning-making is negatively correlated with the severity of medical

professionals’ grief reactions to patient death; (3) self-compassion is positively correlated with

meaning-making of patient death; (4) the better predictor of grief reactions among medical

professionals is self-compassion. (5) nurses are more likely to experience severe grief reactions

than doctors in the context of patient death; (6) self-compassion of doctors is greater than nurses

in the context of patient death; and lastly, (7) meaning-making of doctors is greater than nurses in

the context of patient death.

On the other hand, the qualitative part of this study aims to (1) know the perceptions and

insights of doctors and nurses on their work as medical professionals; (2) explore medical

professionals’ grief reactions over patient death; (3) determine other factors that influence the grief

reactions of medical professionals; (4) examine the impact of patient death has on the personal and

professional lives of medical professionals; (5) explore their use of coping and social resources to

manage their grief reactions; (6) identify and describe the role of self-compassion with the grief

reactions of medical professionals to patient death; and (7) identify and describe the role of

meaning-making with the grief reactions of medical professionals to patient death.

In this chapter, the quantitative results that were analyzed through statistical methods

of correlational analyses, regression analyses, and comparative analysis and the qualitative results

analyzed through Thematic Content Analysis will be discussed further along with related literature

and narratives of the participants.

The Relationship of Severity of Grief Reactions and Self-Compassion

The quantitative and qualitative analyses used in this study support the hypothesis that there

is a negative significant relationship between severity of grief reactions in response to patient death

and level of self-compassion of medical professionals. In particular, the Pearson r correlational

analyses showed there is a significant negative relationship, r(115)= -.279; p= .001, between grief

reactions and self-compassion. Hence, it suggests that as the level of self-compassion of the

participants increase, the severity of grief reactions decrease. Likewise, the higher the level of self-

compassion that medical professionals have, the lower the severity of their grief reactions. These

findings are congruent with the general body of research on self-compassion, which has suggested

that self-compassion can help ease emotional distress and promote positive feelings (Wei et al.

2011) therefore, it can also reduce grief reactions. This can be supported by a study that

investigated the relationship between Atharyan et al.’s (2017) study on how increased self-

compassion level leads to a decrease in nurses’ occupational stress and its dimensions, among

which is grief from patient death.

Moreover, majority of the participants have also associated self-compassion with

compassion for others. The dictionary defines compassion as a deep awareness of others’ suffering

and the wish to alleviate it. A statement from P14 (41, Low) reflects how medical professionals

have associated these two, “it helps you learn how to relate, like you’re in that position yourself”.

According to Kret (2011), compassion is something intrinsic to health care practice. Figley (2002)

states in of of his articles that “...we cannot avoid our compassion and empathy. They provide the

tools required in the art of human service. To see the world as our clients see it enable us to calibrate

our services to fit them and to adjust our services to fit how they are proceeding.”

Another role of self-compassion according to the participants is it helps in balancing

detachment and empathy. In a study by Jeffrey (2016), the researcher stated that having good

emotional detachment contributes to better mental health because it enables physicians to maintain

medical objectivity when handling stressful situations, particularly where attachment may affect

clinical judgment. However, like what P1 (24, High) experienced, “Never ako naging attached to

any other patient like I was to her, feeling ko dahil sa kanya talaga like how she treats me, parang

close talaga kami...” detachment is difficult to maintain in the medical context, they are never

certain if they will or will not get attached because as health professionals they encounter different

situations that can elicit a range of emotions. Also, as mentioned by P19 (20, High) empathy plays

an important role as well because it helps medical professionals to better understand a patient’s

perspective. As medical professionals, their empathic ability allows them to notice the pain of

others and be compassionate towards those who are in pain. But ironically, this empathic ability

of theirs is also related to the susceptibility to stress, burnout, and emotional exhaustion (Davidson

& Harrington, 2002) so it’s important that medical professionals do not over-identify with patients,

for the impact can become negative — for both the patient and medical professional.

Lastly, to further explain the relationship of self-compassion with the severity of grief

reactions, the researchers considered the demographic data. The researchers observed that self-

compassion was significantly higher in medical professionals with more years of experience

compared with those who had less years of experience. This may suggest that medical

professionals develop resilience to patient death over time. Therefore, they have less severe grief

reactions.

The Relationship of Severity of Grief Reactions and Meaning-Making

As hypothesized, quantitative data supported that the severity of grief reactions and

meaning-making have a significant negative correlation. Specifically, the Pearson r correlational

analyses of the study showed there is a significant negative relationship, r(115) = -.289 ; p = .001,

between severity of grief reactions and meaning-making. The results suggest that the higher the

meaning-making score, the less likely he or she experiences severe grief reactions. Such finding is

also supported by literature and qualitative results of the study. Wong (2010) said that the capacity

of an individual to seek and make meaning towards life experiences also creates “purpose,

understanding, responsibility, and enjoyment” in what they do. Every single human has already

experienced or will eventually experience grief from death of a loved one in their lives. This tragic

experience is considered to be a life crisis to every normal person. Filipp (1999) has determined

the relationship of these kind of experiences on the ability of the individuals to also make sense of

that certain event saying, “In victims of life crises and trauma, the transformation of objective

reality into their ‘interpretive realities’ can only be accomplished by ruminative thinking” (p. 71)

One thing we understand is that every individual experience grief differently that no two people

grieve in the exact same way; There are various factors that makes it possible. The severity of grief

may depend on many variables - their personality, cultural factors, social roles, and even the

meaning-making of a person. As research suggests that people who have a close relationship with

the person who died are high risk for grief, and that meaning-making is associated with a reduction

in the severity of these reactions (McIntosh et al., 1993; Murphy et at., 2003).

Regarding the qualitative data that support this study, the researchers were able to extract

roles of meaning-making to the medical professionals that concerned the personal and professional

aspects of their lives. Personal and social resources and nature and eventual outcomes of an

individual affect the way they create the meaning of an experience (Updegraff et., 2008; Park,

2010) This means that all collected themes that defines the role of meaning-making on patient

death experiences among medical professionals are made through personal and professional reason

that also benefit personal and professional outcomes. For example, one participant stated that

meaning-making helped prevent severe grief reactions through making sense of the loss and

accepting death as a natural and inevitable part of life. Just as how this was discussed in Hinderer’s

(2012) study, some medical professionals stated that making this association of death as a part of

life was a pivotal point in their professional career for it prepared them for future encounters with

patient death.

In line with this, majority of the participants, expressed the centrality of death and the

significance it played on how they gave more value to life. There is evidence that many individuals

when faced with loss engage in the process of meaning making as they ask and attempt to answer

various questions, including the “why’s,” “how’s,” and “what’s” related to the death. Often, these

questions lead them into a deeper search about the meaning of life and how they value it. This is

expressed by P14’s (41, Low) response, “I mean, you learn to look at life at a different perspective,

you learn to enjoy every minute, I mean life can be taken from you any minute, any second.”. To

explain this, the researchers attribute this finding to Wong’s (2010) in his study on the positive

psychology of death acceptance, meaning-making motivates people to embrace life and do what

matters most to them.

Moreover, majority of the participants also shared that meaning-making creates an impact

in the improvement of their work performance. Medical professionals shared that through making

sense of their patient death experience, they were able to work better and provide better service to

their other patients. As P28 (33, Low) said, “Mas naging maingat, mas naging … mas ma-

scrutinize, mas matanong, binubusisi. Mas mabusisi ka na doon sa (susunod na) pasyente. Parang

ayaw mo na siyang, ayaw mong may malagpasan ka na importante. Mas-maingat.” Her statement

is supported by the research study of Smith-Han et al.’s (2016) about the experiences of medical

students on death of their patients, these serve as lessons on how they would prepare as a

professional doctor. Furthermore, a similar study found that nursing students and new nurses in

the field apparently give value to early professional patient death experiences for they provide

“helpful and constructive role modeling and improved educational experiences” that is useful on

further patient loss encounters (Gerow et al., 2010).

With these different studies supporting the findings of this research, the researchers could

imply that the ability to make meaning after a loss is indeed a positive coping strategy that can

reduce symptoms of anger, lead to increased wellbeing, and eventually result to less severity of

grief reactions. In essence, it can be inferred from the responses of the medical professionals that

meaning-making is a necessary skill that must be consciously practiced and cultivated with time.

Being able to create meaning towards experiences is an attempt to cope with them (Danhauer et

al., 2005). Shear (2012) also explained that “self-observation and reflection”, which are elements

of meaning-making are important instruments to heal oneself. It is only in allowing themselves

make meaning of their experiences, that they can make sense or find benefit from the experience

so that they could improve their work performance and grow as medical professionals.

The Relationship of Self-Compassion and Meaning-Making

Quantitative results supported the researchers’ hypothesis that self-compassion and

meaning-making has a significant positive relationship. The Pearson r correlation analysis on the

relationship of these two variables suggested a significant and positive relationship r (3) = -.325 ;

p < 0.001. Two components of well-being are about making meaning around one’s life and

forming positive relationships (Ryff & Keyes, 1995). It is possible that self-compassion allows

individuals to construct meaning in their lives and have more positive relationships with others. In

practicing self-compassion, one has a desire to reduce or minimize emotional suffering and to heal

oneself with kindness and nonjudgmental understanding. Rather than seeing oneself as inherently

flawed or of poor character, the individual understands that suffering and flaws are a part of the

greater human experience. Understanding the experience and creating meaning around the

experience is thought to be an important part of well-being (Ryff, 2014). It is possible that self-

compassion and being gentle toward oneself offer the opportunity for the discovery of meaning,

thus offsetting the impact of distress (Gilbert & Procter, 2006).

Meaning-Making as the Better Predictor of the Severity of Grief Reactions

The researchers have hypothesized that self-compassion would be the better predictor of

the medical professionals’ grief reactions severity. Although both variables are significantly

related to the severity of grief reactions, multiple regression analyses showed that meaning-making

is the better predictor variable. The researchers compared the t-values and the corresponding p-

values of self-compassion and meaning-making. The results showed that self-compassion acquired

a t= -2.208 (p= .029) whereas meaning-making got a t= -2.369 (p= .020), indicating that meaning-

making is the stronger predictor of grief reaction severity. Moreover, as shown in Table 9, the

coefficient of determination (R2) obtained for each regression were compared and the results

illustrated that self-compassion acquired an R2 = .279, while meaning-making got an R2 = .289,

which suggest that meaning-making is the stronger predictor of grief reactions. Therefore, it can

be expected for someone with high meaning-making to better handle patient deaths and have lower

grief reactions severity scores. Hence, the findings do not support the fourth hypothesis of this

research that self-compassion is the better predictor of grief reaction severity.

Meaning making, as defined by Oana Marcu (2007), is the process of (re-)construction of

schemes and representations, so that the feeling of order, coherence is reestablished. These

representations comprise the perspectives that a person has on the world and the self, the goals that

the person wants to achieve and relevant events for these goals. In order to recover when

experiencing a disruptive life event, the person initiates, both consciously and unconsciously, a

search for meaning. To explain why the results turned out to be such, the researchers considered

the data gathered from the interviews. In the qualitative analysis, the researchers have observed

that the roles given by the participants to meaning-making were more focused on how they handle

patient death whereas in self-compassion, their responses mostly concerned how self-compassion

makes an impact on their personal lives.

Profession and the Severity of Grief Reactions, Self-Compassion, and Meaning-Making

The independent samples t-test and Mann Whitney U test showed that no significant

profession differences were found in the variables- meaning-making and grief reaction severity,

opposed to what was hypothesized. However, results show that there was a statistically significant

difference between the nurses’ and doctors’ levels of self-compassion.

Specifically, consistent to what was hypothesized, Nurses are connected to higher Hogan

Grief Reaction Checklist (HGRC) scores than doctors and are therefore connected to higher grief

reaction severity. However, results showed that there was no significant difference between nurses

and doctors’ severity of grief reactions in response to patient death. Likewise, Mann-Whitney U

supports this since the U= 1373.50 (p= .063) is not significant at alpha level .05. To explain why

the results turned out to be significant on the opposite direction, the researchers suspected that

nurses follow many patients in one day and are more likely to be involved when the patient’s

condition deteriorates and requires more advanced care (Plante & Cyr, 2011). This can also be

attributed to the scale that was used to measure grief reactions, the generality of the nature of items

used in Hogan Grief Reaction Checklist. The items in the scale are not designed or constructed to

pertained to grief reactions in response to the death of a patient since the questions are general.

Some of the questions talked about disorganization, which the participants possibly could have

interpreted it generally. Although to some extent, scores in HGRC can measure one’s grief

reactions when it comes to patient death discussions since it tackles the common manifestations

of grief which are despair, blame, and anger. It’s just a possibility that this could have affected the

significance of the difference.

For meaning-making, the researchers have hypothesized that there is a significant difference

in nurses’ and doctors’ level of meaning making. They also assumed that doctors have higher

meaning-making than nurses; however, the results proved otherwise. The level of meaning-making

for nurses and doctors did not differ significantly at .05 alpha level, t(113)= -.424, p= .337.

Furthermore, when the researchers conducted Point-biserial correlation it was found that nurses

are more related to higher meaning-making than doctors. To explain why the results turned out to

be not significant, the researchers have suspected that situational factors??? have affected the

results. One’s level of meaning-making may be the result of his or her different experiences in the

profession. For example, P61 (23, High) explained that in a way, nurses deal with death differently

compared to doctors. “Iba kasi yung training ng doctors sa nurses. Sabi ng consultant na lagi

namin kasama kapag nagrrounds is pag nurse ka you are trained to give care and support talaga.

Pag doctor ka you train on how to manage the patient medically.” In line with this, their

differences in level of meaning-making may not be due to profession, but also, individual

differences and other experiences aside from patient death should be taken into account for.

Lastly, for profession differences in self-compassion, the quantitative analyses of the results

partially support the hypothesis of the researchers that there is a significant difference between

nurses and doctors in measures of self-compassion. However, contrary to what was hypothesized,

correlational analysis revealed that nurses are more related to higher Self-Compassion Scale (SCS-

SF) scores than doctors. Tests of difference elaborated on this, the results of the t-test also show

that nurses had significantly higher self-compassion compared to doctors t(113)= -2.285, p= .012.

The explanation as to why nurses have higher self-compassion can be attributed to the findings of

Gustin’s and Wagner’s (2013) study on nurses, that being self-compassionate plays an important

role in maintaining their mental health and having more compassion for others, which has been

shown to have a significant impact on patient outcomes. Also a possible reason why doctors turned

out to have lower self-compassion than nurses is as stated by P47 (30, Average) some doctors

sometimes get feelings of guilt for believe they had some responsibility for it or didn't do enough

to save the patient (Gerow, 2010).

Insights about the Medical Profession

Through the qualitative analysis, certain insights about the participating medical

professional were gathered through the interviews. These insights include their self-concepts as

professional in the medical field and the best and the difficult aspects of their profession. Presented

in Table 15 are the collected abstract themes on medical professionals’ self-concept - being able

to help, being able to fulfill their duty, and being someone who continuously learn. In the same

table, the best and difficult aspects of their job were also explored.

Baldwin et al. (1987) studied self-esteem of nurses and found that their self-concept and

self-evaluation is highly correlated on their economic status as medical professional. According to

Hoeve et al. (2013) self-concept of nurses and their professional identity is influenced by their

“public image, work environment, work values, education, and traditional social and cultural

values”. In this chapter, we also explore the self-concepts gathered from medical professionals

who participated in this study.

To begin with, medical professionals view themselves as individuals who are capable to help,

hence, also make difference on the lives of their patients when they provide help. P14 (41, Low)

said, “I perceive myself as someone who’s able to help people and that makes me feel good. I get

to make a difference.” Researches showed that medical professional – patient relationship revolves

on doctors and nurses providing care, giving help and being responsible for their patients (Natan

& Becker, 2010; Goold & Lipkin, 1999). Their view about their profession is directly and primarily

connected on their duty to comfort the patient to relieve any pain and illnesses (Jecker &

Schneiderman, 1993)

Connected with the first theme of self-concept, medical professionals perceived themselves to

be involved with their job as much as they can. Their perception that medical professionals, must

fulfill their duties and fulfill their oath to their profession. P17 (47, Low) said “as long as my

health permits… Ano kasi yung doctor eh, vocation ‘yan eh”, explaining how it is possible for him

to view himself as a medical professional who fulfills his duty as a physician. Takase & Burt

(2002) reports that professionals, like nurses, in the medical field views themselves based on their

roles, values, and behavior, in which, we could conclude that the idea of the participating medical

professional on themselves as someone who fulfills their duty is influence by their professional

roles.

Lastly, medical professionals perceive themselves as individuals who learn continuously

with their working experiences. According to Gregg and Magilvy (2001), it is natural that nurses

and even physician take their work experiences as learning tool to improve themselves. P37 (28,

High) shared, “I think, as a doctor, I’m someone who’s got a lot to learn, still. And, I know I still

have a long way to go. I’m someone who’s thirsty for knowledge, and I’m not really afraid to ask

questions.” Education and work experiences complete the factors that make up the understanding

of the role of a medical professional (De Araujo Sartorio & Pavone Zoboli, 2010; Hoeve 2013).

Nettleton et al. (2008) presumed in their study that medical profession required a system

that is “objective, trustworthy, reliable, effective, competent, and fair”, thus, also require medical

professionals to be “caring, emotionally intelligent, intuitive, and sensitive”. In this current study,

the researchers abstracted themes on the best aspects of the medical professions. The participants

shared how relieving patients of their illnesses, receiving gratitude from patients and their relatives,

earning respect from society, and getting to know the patients are regarded to be the good

experiences of medical professionals in their job. As we elaborate these themes, Graham (2006)

clarifies the importance of appreciating the lives of the medical professionals.

Based on the results, the most recurring theme on the best aspects of being a medical

professional is being able to relieve and save patients from their illnesses is one of the fulfilling

experiences as medical professional. P19 (28, Average) shared, “It’s very rewarding if you do your

job well, so ganun, parang, uhm, you save, you address the problem and then you prevent them

from having complications and then when you get to send them home, that’s very fulfilling.” Kent

et al. (2012) found statements in their study similar to our theme; they disclosed how “provision

of quality care” to patients brings a rewarding feeling to medical professionals.

Another aspect is receiving gratitude from patients and relatives of the patients It is

humbling for doctors to receive expressions of gratitude from their patients (Nettleton et al.

2008). In the same study, patients in the departments in oncology, pediatrics, and renal medicine

receives cards and letters as a form of giving their thanks to their attending physicians.

Participants in this research shared the words of gratitude they receive from their patients, which

are: “Thank you, doc.” and “Thank you for saving my mom.”. Kent et al. (2012) also found in

their study that recognition of their efforts for attending their patients is appreciated in their job.

Goold & Lipkin (1999) describe in their study that effective use of doctor-patient

relationship like good interaction gives patients a sense to express respect towards the doctors.

Similar to P47 (30, Average)’s statement, which is, “It’s actually more of a being able to reach

out to people, and how they see you in a different light, parang they see you in a regarded person

in the society.” A study also introduces that doctors take benefit in receiving a privileged position

in society as an individual and as a professional (McKinlay and Marceau, 2002; Lipworth et al.,

2013) Our society respects people who mostly contribute to the betterment of the community. A

medical professional, that has the knowledge and skills to save people from different medical

condition, earns the respect of the mass.

Medical professionals shared that being able to know the patients personally is one of the

best aspects of their profession. P1 (24, High) shared,

“very interesting malaman yung history nila, yung bakit sila nagkaganon, yung context,

like for example siguro yung part ng culture, socioeconomic status, and lalo na, yung

personality nila that’s the part I look forward to getting to know the most.”

Medical professionals take pride in creating connections among their patients and their

families. A reason for this is comfort for between the relationship of the medical professional and

the patient. In same study of Kent et al. (2012), nurses, who participated in his study, state their

satisfaction in building “good rapport” with the patient and the family. This aspect is also

significant as their meaningful interactions assist themselves – both the medical professional and

the family, to cope up easily towards unfortunate events like patient death.

However, Riley (2004) introduced that there are principles and aspects in the nature of

medical profession that leads to stress; these affected them personally and professionally. In our

current study, having lack of personal time, poor local healthcare system, experiences of sympathy

for the bereaved families, and suffering the risk of burnout that comes with their job are included

as difficult aspects of their work as medical professional.

Having lack of personal time is the most common difficult aspect abstracted from the

participants. P32 (45, Low) explained, “Lalo na of course yung time, time talaga, minsan sa

sobrang busy wala na akong time for my family, lalo na sa anak ko. Sometimes hindi ko rin

natitignan lahat ng patients, kasi as a person may limits ka rin.” Though, it is known that doctors

and nurses should always be reachable when duty calls. Weinstein (2002) wrote that those who

work in the medical field have struggles with their work hours, regardless of having not enough

personal time, insufficient patient care and excessive fatigue possibly results due to this aspect.

Poor healthcare system, as introduced by P112 (24, High), “Maraming hindi nakakapag-

afford, hindi din nakakatulong na malaki gagamiting pera sa healthcare”, is a problem also face

in the medical profession. Having poor quality of healthcare not only threatens the condition of

the patients, but also impedes the progress of medical professionals. Inaccessibility of health care

among poor families manages to put medical professionals in blame due to the part wherein

physicians and nurses are kept out to reach them too.

Connecting themes which are patient death experience and sympathy with the bereaved are

also included on the difficult aspects of medical profession. P14 (41, Low) shared, “One that’s

more difficult is feeling bad for the people who are left behind. I don’t feel bad for them (those

who died), because they’re at peace. I feel bad for the people that are left behind.” And P1 (24,

High) said, “Uhm yung namamatayan. Yun yung most difficult aspect besides the obvious na you

can’t save everyone…” Hence the inevitability of such experiences in the medical field, Teno et

al. (2001) suggested that providing high quality medical care should still include assisting dying

patients their desired comfort, relieving family members of the patient the burden of the pain of

their loved one, and giving enough emotional support before and after the patient’s death.

Lastly, risk for burnout is also a problem in the medical profession. Similar to lack of

personal time, having a busy schedule and jam-packed workload are determinant of burnout

(Janssen et al. 1999; Schaufeli & Buunk, 1990) P19 (28, Average) shared, “I don’t get off. Wala

akong, di kasama yung holidays, so eventually burned out ka. And parang maiisip mo how can

you function 36 hours straight if tuloy-tuloy lang talaga.” Gopal et al. (2005) described the burnout

experiences of internal medicine doctors by working long hours wand having no control over their

schedule.

Grief Reactions to Patient Death

According to previous studies, grief is not only experienced by families when the patient

dies, but also by nurses who take care of the patients (Shimoinaba et al., 2014). Although, the

findings of this study have already proven that medical professionals are indeed capable of feeling

grief the researchers further explored the grief reactions in response to patient death of medical

professionals. For the qualitative part of this study, the participants were asked to describe what

they have felt during and after the patient’s demise. The participants described a range of reactions

in response to patient death.

This study’s findings on grief reactions corroborate with Granek’s previous research on

Canadian oncologists’ grief wherein he indicated that some emotional reactions to patient death

are generalizable across cultures. In this study, Filipino medical professionals reported to have

experienced sadness, crying, acceptance, guilt, rumination, and disbelief. These results are similar

to the finding of previous studies (Conte, 2014; MacDermott & Keenan, 2014; Marcella & Kelley,

2015). Most of the participants described feelings of sadness when they encounter patient death.

Some of the participants shared that they had cried because a patient had died or was about to die,

or because they had to deal with a patient’s family after a death. This can be supported by Wagner

et al. (1997) their study’s findings showed that crying was frequent in hospitals; 57% of doctors,

76% of nurses and 31% of medical students had cried at work in the hospital at least once, with

the main reason for all respondents' crying being identification and bonding with suffering and

dying patients or their families. This could also be supported by qualitative data gathered from the

respondents. P19 (28, Average) stated that “I had to excuse myself from the family and then umiyak

nalang sa restroom.”, the same study by MacDermott and Keenan (2014), indicated the same

situation wherein medical professionals felt they had to hide their crying to be professional.

Moreover, it was found that participants react with their grief through acceptance. Many

participants from other researches dealt with patients’ death as a matter of fate and as a normal life

process beyond human control (Shorter & Stayt, 2010; Yu & Chan, 2010). P47 (30, Average)

mentioned “Wala accept mo nalang rin naman talaga na sometimes… actually medicine is a very

humbling experience kase of course hindi lahat ng bagay under your control, and you realize that

there are things na hindi mo alam”. In some cases, a feeling of relief was described when a patient

had a particularly long, drawn out or painful experience.

Medical professionals also described feelings of guilt and a sense of self-questioning, the

participants described feeling guilty when they were unable to cure patients, when they had to

explain to the family that the case was hopeless. In addition, they reported guilt over feeling like

they could’ve done more to save the patient. As P14 (41, Low) aptly noted, “When you feel like

you could’ve done a little bit more. It bothers you. You start thinking about it like you ask yourself

had you done something different, would it make a difference?”. Related to feelings of guilt was a

sense of self-questioning that followed many patient deaths. Self-questioning had to do with the

dual sense of professional obligation to ensure that one had done their job fully after a patient died

and a sense of worry that one could have missed something that may have prevented the patient’s

demise. These findings can be attributed to a similar qualitative study on nurses’ experiences of

caring for dying patients, fear, guilt, powerlessness, and frustration as emotions related to patient

death (Granek et al., 2012). They have expressed sadness, depression, despair, recurrent thoughts

about the deceased (Granek, Krzyzanowska, & Tozer, 2015; Genevro & Miller, 2010). The same

emotional reactions mentioned by the participants like experiencing sadness, relief, and guilt were

also found from different studies that is common after experiencing patient death. (Hinderer, 2012;

Redinbaugh et al., 2003).

With regards to how grief reactions can be related to the variables of this study, a research

showed how emotional intelligence develops a caring relationship between a medical professional

and a patient. James, Andershed, Gustavsson and Ternestedt (2010) explained how emotions,

thoughts, judgements and actions are interconnected with each other. In their research, they stated

“the combination of emotions and thoughts increases abilities to demonstrate sensitivity and

compassion” which is observed from the statements of the interviewed participants when asked

about the reactions towards patient death. P14 (41, Low) expressed “It made me more caring. It

made me more sensitive as a person.” when asked to reminisce his patient death experiences. As

reported from the interviews, the most unforgettable patient death experience was influenced by

the amount of time and attachment they built when they had the patient under their care.

Redinbaugh et. al (2003) supported this with his previous study that those physicians that spend

longer time of taking caring of their patients and get to know them makes them more sensitive to

emotions from loss.

Factors that Influence Grief Reactions

The qualitative part of this research also explored other influencing factors that make some

patient losses particularly more difficult for medical professionals. Among these factors - patient-

related factors, family-related factors, and disease-related factors - the patient-related factor,

patient age has the highest frequency. In a study by Granek on difficult patient loss for oncologists

(2012), results also showed that doctors are more affected when a patient that is particularly young

dies. In the same study, the other factors that made patient death particularly challenging as

indicated by the oncologists are in accordance to the findings of this study. In this study, factors

like having close relationships with patients, where the medical professionals felt close to their

patient and have treated them for a long time, and identification with patients, where patients

reminded them of family members. Moreover, although a disease-related factor, unexpected death

was also one of the factors mentioned by Granek.

In Table 16, family-related factors were also presented. According to Yang and Mcilfatrick

(2001), the difficulty of dealing with patients’ bereaved relatives is identified as a source of stress.

In this research, there are participants that identified having to deal with the patients’ bereaved

families and seeing the impact of the death on patients’ families are factors that make a death more

difficult. One participant, P14 (41, Low), specifically reported that he doesn’t really feel bad for

the patient that much, he feels bad more for the people left behind, the family. Another family-

related factor that showed up in this study like physician blame has also been reported in Granek’s

previous research (2012). Filipino medical professionals though tended to focus more extensively

on close relationships with the patients’ families and the emotional reactions of the patients’

families being the factors with the most influence on their grief. In this research, more than half of

the respondents considered that addressing the families’ emotional reactions was a factor that made

it difficult for them to deal with the death. Furthermore, when asked about the most difficult aspects

of being a medical professional, sympathizing with the bereaved was one of the abstracted themes.

To explain this, the researchers suspected that these two are possible sources of stress for the

medical professionals.

Also, based on the results, medical professionals also find it most difficult when their patient

died unexpectedly or of an unforeseen complication, and when the patient had a ‘Bad’ death

(painful death or inevitable death). In the case of P17 (41, Low), the patient’s family asked him to

seek even unconventional treatments, in hopes of getting to save their loved one but there wasn’t

really anything he can do, making it difficult. This finding is supported by Granek’s (2012) study

that also explored the factors that make patient loss particularly difficult for oncologists. As stated

in the previous study, excessive treatments that no longer had curative purpose requested by the

family, made the loss harder. Moreover, the researchers suspected that the participant may have

felt pressured by the family to provide more treatment that he knew wasn’t necessary.

Furthermore, majority of the patients reported that unexpected deaths are harder to deal with

than an expected one. It is said that different emotions are triggered when one knows that death is

imminent versus when it comes "out of the blue." In the current study, seven out of twelve

participants expressed that the grief was intensified when the death is sudden and less intense if

the patient was terminally ill and had suffered for a long time. As stated by one of the participants,

P37 (28, High) “she would be my most memorable patient na na-pass on during my care...biglaan

yung death niya, I was devastated, and I wasn’t really expecting it, so I was shocked.”. These

findings are supported by Shorter’s and Stayt’s (2010) study that states how perceived grief was

less traumatic when the patient’s death was anticipated and expected.

Impact of Patient Death Experiences

The patient death experiences of the medical professionals affected both of their personal

lives and professional lives. Under personal impact, emotionality, desensitization, compassion

and, self-esteem is affected. Granek et al. (2012) said in their research grief has an impact in which

work life and personal life are difficult to separate due to patient loss experiences.

As introduced on the results, the emotional reactivity of the medical professionals is deeply

affected by patient death. P14 (41, Low) shared “I didn’t think that I was the sensitive type of

person, but I seem to have gotten affected.” Meier et al. (2001) discussed in their study that caring

for terminally ill patients elicit “powerful” emotional reactions to medical professionals which

explains this theme suggested by the participants and claimed by P14 (41, Low). With this

information, Weiner & Cole (2004) explains that emotional awareness of medical professionals is

important, thus, they should consider also regulating their own emotions towards grief if they

ought to receive less of its impact in their work and personal lives.

Next, desensitization is about how initial high emotional reactivity of medical professionals

on patient death is now claimed to be less to having no emotional reaction at all. On Granek et al.

(2012)’s study, one of their participants explained the impact “I think you just get exposed to so

much death that you just become somewhat accustomed to it.... It’s part of our job” which

relatively P61 (23, High)’s statement in this study “Pero with the following na mga deaths sa mga

patients parang sometimes I feel na wala na, nasasanay na ako.” Desensitization is defined to be

formed by being in contact to repeated stimuli – exposure to large amount of patient and emotional

resources getting used up (Curzer 1993; Greenwood, 1993)

Compassion, on the other hand, is developed through patient death experiences. Medical

professionals explained how patient death also gave positive impact to their lives. As mentioned

earlier, P14 (41, Low) said, “I’m more compassionate (now). I’m more caring as opposed to, when

I was younger. 20 years ago, I wasn’t you know, I wasn’t as compassionate as I am now.” Studies

from Figley (1983) and Hooper et al. (2010) explain how compassion is one of the core values of

medical professionals especially in the field and most often compassion fatigue is experienced too

when exposed to stressful events on work. Contrary to this, the findings in this study propose that

stressful events like patient death allowed the participant to become more compassionate to their

patients.

Lastly, under personal impact of patient death, lowered self-esteem is reported to arise due

to tragic professional experience. Normally and according to Carroll & Coetzer (2011) who studied

the brain-undergoing trauma, grief is negatively associated with self- esteem. If medical

professionals experience difficult attitude towards patient death – grief, then it is possible that their

self-esteem is reported to lower. P28 (33, Low) said, “Siguro may time na ganon (bumaba

confidence) lalo na kapag komplikado yung mga nakakasalamuha kong mga pasyente. May times

na I ask myself kaya ko ba ito? ... Baka magkamali ako, mamatayan ako (ulit).” Medical

professionals’ personal value is affected due to experience of patient death. Studies show that

medical professionals who seem to be make their professional lives too seriously are subject to be

affected when failure comes (Carmel, 1997; Fitts, 1972; Super, 1963). Self-esteem of a medical

professional also links on their competence as physician or as a nurse. The more competent or

agile they are to avoid failure or loss of a patient, the more negative impact it has to their self-

esteem.

It is also unavoidable how patient death affects the professional lives of the medical

professionals. Under this, their work performance, learning experience, detachment from patients,

and work motivation are found affected through this study. Peters et. Al (2013) found that patient

death affects medical professionals professionally as they discover their limitations and improve

their services.

Many of the participants in this study found that experience of patient death positively

affected their work performance. Studies also show that when physicians were asked what could

be the most memorable event in their job, they answered mostly with mistakes they’ve

encountered, hence, this incidences didn’t affect the quality of service they give but improve them

(Firth-Cozens & Greenhalgh, 1997; Mizrahi, 1984). P10 (26, High)’s statement summarizes the

increase in work performance she experienced as she said, “With other patients, mas naging

maingat kami. Hindi naman sa sinasabi ko na hindi kami maingat dati pero kasi dati naooverlook.

Yung kami ngayon parang pag may off lang na konti sabihin kaagad sa residents” Similar to this

is a statement on one of Granek et al. (2012)’s study about patient loss “It does make you more

careful about what you do… it turns into more like a reality check that you really have to try

harder, and try to do more rather than accept the status quo; what we are offering patients is not

good enough.”

Another professional impact of patient death experience is providing learning experience

to improve as a medical professional. P32 (45, Low) shared, “For every death na ganon, kung

careful kana, mas nagiging careful kapa…mas natututo kapa so para sa next time, eto na yung

gawin ko, hindi ganito, or iiwasan ko ito para hindi ganito (ang mangyari). Kumbaga it’s a

learning experience…” A study of Kent et al. (2012) on early experiences of nurses on patient

death had similar results with our current study, learning experience was also found as an impact

from patient death experience. From the same study mentioned above, their participants mentioned

how patient death “provided them with a beneficial or necessary learning experience and, for some,

it was largely viewed as an opportunity to attain professional skills and knowledge.”

Based on the results, detachment from patients was reported as a professional impact.

According to the study of Hawkins et al (2007), an insecure attachment style of a patient-nurse

relationship leads to nurses being more vulnerable to stress in experiencing patient loss. P10 (26,

High) explained, “As a doctor, dapat meron kang sympathy sa patient but you have to detach

yourself, so you don’t get too emotionally attached to your patient kasi ikaw yung doctor nila. You

have to think as a doctor not as a relative.” The impact of patient death to medical professionals

regarding detachment leads to regulation of their work performance and prevention of severe

emotional responses – such as grief. Granek et al. (2012) also introduce that being able to create a

boundary between emotions and distance to patients will avoid pain when experiencing patient

death.

Lastly, work motivation is greatly affected because of patient death. Medical participants

shared experiences where their motivation increase while others reported a decrease. P19 (28,

Average) who was more motivated after experiencing patient death because he knows that his

patients need him,“mas lalong motivated ako…kasi mas lalo kang kailangan e. yung mga doctors?

kulang. mas lalo kang kailangan. P112 (24, High) shared that initially her motivation decreased

but eventually increased due to realization of how much patient she could still save. Studies

explains how motivation is necessary for medical professional to cope up and keep up with the

work demands in the medical field (Bellack, 1999; McQueen, 2004)

Existing Coping Strategies in Dealing with Patient Death

Medical professionals are often confronted with stressful situations, among which is patient

death, so the must learn to cope and manage these experiences in order to function effectively in

their work. Therefore, medical professionals must have strategies that allow them cope with patient

death and the grief that comes with it at the same time, balancing as much as resources around

them to fully function as a physician or nurse as part of their duty. Lindemann (1976) explained

the necessity of studying grief generally with the mechanics and process of grieving and

significantly the functional and operational way that explores several coping activities. Noted

through this research, the participants introduced five different themes on how they cope with grief

– through social support, carrying on with work, professional support, faith, and time off work.

Majority of the participants identified being able to talk about the experience with their

family, friends, and colleagues as a coping strategy. Studies show that social support, which

includes understanding, sympathy, and help from others, is useful as it decreases the possibility of

being lead towards harmful engagement to grief experience - avoidance and denial (Blankfeld,

1999; Calvete & de Arroyebe, 2012; Fleishman et al., 2000). P10 (26, High) shared, “You have to

have an outlet afterwards, from your colleagues, your relatives, your mother or father ganun. Kasi

if you don’t open up parang maaapektuhan din yung work mo.” This is supported by previous

similar studies that have found social support as an essential coping mechanism used by healthcare

professionals who have lost patients, for these social support systems helped them deal with their

own grieving process (Kreicbergs et al., 2007; Fleishman et al., 2000).

Some people cope, in a way, by immediately going back to work and just carrying on with

what they were doing. Bento (1994) wrote “the show must go on” on his paper about grief and

involvement with work in organizations, Similarly, medical professionals who participated in this

study introduced how carrying on with their work is also their way of coping with grief on patient

death. P14 (41, Low) who shared how patient death is also the reason to help him cope in this way,

“despite the losses we still get to save people. So even if we lose 10 people a month, we also

save a hundred people a month. So, if we go by statistics, were still good. I guess that helps

us in coping kase we lose some, but we save a bit more than we lose. I just think that you

can’t save everyone so you just have to do what you can.”

This view on carrying on with work doesn’t support studies that reported medical

professionals distinguish their grief by “remaining calm” first to be focused with their duty then

grieve later (Gerow et al., 2010; Onsott, 1998). Tehan & Thompson (2013) ’s study, on the other

hand, consider the value of returning to work and handling their duty “sensitively and

appropriately” which reflects the definition of the theme about carrying on with work. According

to Hazen (2008), there are times that “work itself is healing” especially when this way of coping

provides meaning for the griever.

The next theme to be discussed is professional support. It is defined as a coping strategy of

medical professionals that are provided by their workplace and also help sought with other

professionals that assist individuals on grief recovery. P14 (41, Low) didn’t undergo grief

counseling himself, he mentioned that their hospital provides grief counseling for their doctors and

nurses, if they need to. Also, one participant mentioned that most hospitals have conferences

wherein different doctors discuss the cases of patients who died. In their study, Hazen (2008) and

Stein and Winokuer (1989) had drawn that organizations and workplaces can bring support to their

employees by providing grief training and workshops, assistance programs, institutional support

groups, and grief counselors.

Research showed that culture and religious beliefs has influence on individuals on how

they take death and dying (Depaola et al, 2003). The influence of religious beliefs in this current

study in introduced as participants shared turning to their faith is a way for them to cope with grief.

Yang & Mcilfatrick (2003) had participants, who are nurses, in their study that believed having

religious support helps in decreasing the feeling of distress and helps them also to accept patient

death. Similar to one of the participants in this current study, P32 (45, Low) said, “I pray, nagp-

pray ako syempre tapos tapos nabibigyan ako ng tibay ng loob gaya non… after my patient died

at the hospital, I went to a church nearby.” Having religious beliefs to rely on times of grief makes

the experience with less anxiety, depression, and distress as religious beliefs leads positive and

purposive outlook towards death (Tu, 1997; Wu & Volker, 2009).

Lastly, taking time off work was another strategy for medical professionals to cope up with

grief. According to Corr (1999), taking time off work is one of the “customary sources of support”

towards experience of grief. As P61 (23, High) also suggested a break after a patient’s death to

cope. When she said, “I isolated myself muna. Parang I don’t know what to do kasi since I was so

depressed until na mag decide ako na to work again na I’ll try again”, her statement was also

taken significantly in this study. It was discussed in this paper that one of the difficult aspect of

their profession is having not enough personal time. Physicians and nurses do not usually take time

off as their duty demands it but, in this case, taking time off work is considered as a helpful strategy

to cope up with patient death. Lyckholm (2001) define time off as a “complete time away from

patients”, “turning over responsibility to an on-call person for them” and as “time to devote to

family and friends”. It was also elaborated in the aforementioned study that rest and taking time

off work is a way to deal with stress, burnout, and grief in the medical field.

To summarize, social support, carrying on with work, professional support, turning to faith,

and taking time off work are the existing coping strategies suggested by the medical professionals

who participated in the study. In Firth-Cozens & Field (1991) study, it was said that

rationalizing/accepting, supporting the patient, talking to others for support, and the composite

group avoidance, denial and dismissal are suggested coping strategies of medical trainees which

reflects to most of our results.

Chapter 6

Conclusions and Recommendations

As an integration of the quantitative results, qualitative results, and related literature, the

findings revealed a significant relationship among grief reactions, self-compassion, and meaning-

making. This chapter provides the synthesis of the findings in this research, the researchers’

inferences in the study, and how this study can be improved further for future researchers who are

similarly interested in this particular field or topic.

Those who work in the field of medicine know that encountering patient death is part of

every medical professional’s clinical experience both while in training and in subsequent practice.

However, although patient death is a common occurrence in the medical field, there is less research

specifically concerning medical professionals’ experiences, as compared with the many studies of

patients and their families with respect to this phenomenon. Having been aware of such

phenomena, the researchers focused on the particular variable, grief reactions in response to patient

death, throughout the execution of this study. Moreover, the researchers explored the relationship

between self-compassion and meaning-making, with a corollary emphasis on how these two

variables affect one’s grief reactions in response to patient death. The researchers stand on the fact

that our healthcare providers may feel grief over the deaths of their patients and experience

behavioral, cognitive, physical, and emotional grief symptoms when patients die despite the claims

that medical professionals that do so are deemed to be unprofessional. With these principles the

researchers asked to explore the relationships between grief reactions, self-compassion, and

meaning-making in the context of patient death.

There was a determined significant negative relationship between the variables, grief

reactions and self-compassion, as suggested by the different analyses used in this study. This

means that the higher level of self-compassion a medical professional has, the less severe the grief

reactions were and will be, and vice versa. Considering also the interviews with the participants,

the majority regard self-compassion of great importance when it comes to handling patient deaths.

Most of the respondents of the interviews give importance to self-compassion for it seems to help

them cultivate mindfulness and promote positive feelings. Also, the dominant understanding of

the participants towards self-compassion is equating it with mindfulness. This means they view

self-compassion as a necessity for keeping up with their struggles in their daily lives as medical

professionals, not just when they experience patient death. These medical professionals also

acknowledged that self-compassion affects their mental health and overall well-being.

Discussing the second hypothesis, results also show that there exists a significant negative

relationship between the variables grief reaction severity and meaning-making. Hence, it can be

inferred that those who have higher levels of meaning-making are less likely to experience severe

grief reactions. This means that meaning-making may have a great influence or impact to coping

with patient death. Results show that the correlation between these two variables isn’t that strong

but the qualitative analyses prove it otherwise. Based from the respondents’ testimonies, most of

the participants regard meaning-making as a big factor in preventing grief reactions. In addition to

this, these professionals also noted that meaning-making improves work performance. With this

in mind, the researchers infer that for medical professionals, it is only in allowing themselves make

meaning of their experiences, they can make sense or find benefit from the experience so that they

could grow as medical professionals.

Correspondingly, the findings have suggested that there is a positive correlation between

self-compassion and meaning-making. This finding is in accordance to what the researchers have

suspected. This suggests that medical professionals who have high level of self-compassion have

high level of meaning-making. Likewise, those who have low self-compassion also have low

meaning-making. The relationship between self-compassion and meaning-making can be

explained by having a look to the participants’ narratives. One explanation of this is the

participants’ perceived roles of self-compassion and meaning-making. In the questions regarding

the roles of self-compassion and meaning-making in handling patient deaths, the usual answers

include how these two variables help them cope with the experience and find personal growth.

Interestingly, literature also supports this finding, according to Ryff and Keyes (1995), self-

compassion allows individuals to construct meaning in their lives and have more positive

relationships with others and a more positive outlook in life.

The researchers’ hypotheses about profession differences between the variables, grief

reactions and meaning-making, were not supported by the quantitative and qualitative analysis.

The researchers’ hypotheses state that nurses have higher grief reaction severity and that doctors

have higher meaning-making. However, the findings suggest that in there weren’t any significant

differences between the two groups in terms of grief reactions and meaning-making. Results from

Point-biserial correlation also supported these findings. There are no clear explanations why the

results turned out to be such. Researchers suspect that these findings might be partially affected by

the nature of the instruments used. Qualitative analyses, on the other hand, couldn’t have provided

enough evidence for the researchers weren’t able to obtain an equal number of respondents from

the two profession groups.

On the other hand, findings have shown that the differences between levels of self-

compassion are significant. Although the difference is significant, it must be noted that contrary

to what was hypothesized, nurses obtained higher self-compassion scale scores than doctors.

Therefore, it should also be noted that the differences might be an outcome of situational and

individual factors rather than profession. Same goes for the other variables as well, these

differences, significant or not, between doctors and nurses could be a result of many interacting

factors rather than just one. When pediatric nurses are faced with the death of a patient, the way in

which they respond to patient death has been found to be relative to other extraneous factors. These

factors include, previous death experiences, personal grief history, professional nursing ethos and

the workplace environment contribute to the grief response a nurse may display (Papadatou, 2009).

The better predictor of the severity of grief reactions turned out to be meaning-making. Its

relationship with grief reactions was proven to be significant. The researchers have hypothesized

that self-compassion would be the better predictor, but the result wasn’t in accordance with the

hypothesis. Although both variables were significant predictors, meaning-making obtained a

higher p-value. To explain this relationship, the researchers have considered findings in the

qualitative data. In the participants’ testimonies, majority emphasized the importance of meaning-

making in handling patient deaths and in being a medical professional. Moreover, studies have

found that meaning-making is associated with the reduction of severe grief reactions and provides

“helpful and constructive role modeling and improved educational experiences” that is useful on

further patient loss encounters (McIntosh et al., 1993; Murphy et at., 2003; Gerow et al., 2010).

To further understand and conclude findings on the relationship of profession, self-

compassion, and meaning-making with grief of medical professionals, significant qualitative data

that attain the objectives of this research were extracted from the narratives and were further

explored by the researchers. The following are some specific conclusions:

A. Noted insights about their self-concept as a medical professional and the best and difficult

aspects of their profession are described. Participants perceived themselves as medical

professionals who are able to help, able to fulfill their duty, and continuously learning. For

them, the best aspects of their profession include relieving patients of their illnesses as the most

recurring theme. Receiving gratitude, earning respect from the society, getting to know their

patients also comprises the best experiences in their job. Meanwhile, difficult aspects such as

having lack of personal time, poor healthcare system, sympathizing with the bereaved,

experiencing patient death, and risk for burnout were also found.

B. Grief reactions of medical professionals were listed - sadness, crying, acceptance, guilt,

rumination, and disbelief. It was also found that majority of the participants’ initial reaction to

patient death is sadness. The sadness, often associated with crying, felt by these medical

professionals are due to their value of the patient’s life, the family left behind, and feelings of

failure for not being able to do their duty as a doctor or nurse, which is to prolong life.

C. The factors most likely to influence grief reactions were because of patient-related factors such

as closeness to patients, identification with patients, the deaths of young patients. Participants

also mentioned that family-related factors made patient death harder for them to take. These

included having a close relationship with families, seeing the emotional reactions of the

relatives, and dealing with the bereaved family. Dealing with grief over patient death and at

the same time helping the family to understand the death of the patient makes it the most

difficult, especially when the patient’s family show gratitude even when they fail to save the

patient. Finally, disease-related factors such as sudden and unexpected death and ‘bad’ death

also influence the grief reactions of the medical professionals and make these deaths

emotionally challenging.

D. In the interviews, participants shared how their emotionality, work performance were affected

by patient deaths Limited impact from patient death were told, and other narratives that

mentions ideas that comprises self-compassion and meaning making are the reason how

initially negative effects of the patient death turn out to have effects that are taken positively.

E. The most common strategy used by medical professionals to cope in dealing with patient death

is having solid social support systems. Frequent studies also introduce how social support is

significant not only when dealing with patient death but also in general work of medical

professionals. Basically, the coping strategies found in this study have helped these medical

professionals to recover from grief and efficiently get back to work.

F. As patient death is included as a difficult aspect in the medical profession, self-compassion

plays a part to handle own pain and shortcomings of a medical professional. Self-compassion,

in this study, cultivates mindfulness, develops compassion to others, improves mental health

and well-being of the doctor or nurse, and helps balancing detachment and empathy that is

both significant to the job of medical professional.

G. Medical professionals in this study believe the role of meaning making from their grief

experiences provided large improvement on their personal and professional lives. As patient

death is recurrent experience in their profession and as every patient death gives different story

to them, participants think of them as learning instrument to become a better doctor or nurse.

Being a medical professional is identified as a physically and emotionally demanding

profession that may tax nurses and doctors to the point of exhaustion (Mulligan, 2004). These

healthcare providers cater to diverse patient populations and are challenged to adapt to an ever-

changing healthcare environment and the demands of individual patients and their families.

Sometimes they may experience great emotion when caring for dying patients as they continually

try to do their best just to save the patient. People, especially hospital administrators, educators,

and leaders, must understand the impact of medical professionals’ grief following the death of a

patient for whom the doctor or nurse has cared to enable them to cope and maintain healthy

professional lives in a supportive clinical environment.

The findings of this study suggest that more research on medical professionals’ experiences

with patient death is needed. The more knowledge medical professionals, especially the student

doctors and nursing assistants, have about patient death, their experiences with death, and dealing

with family members of dying patients can improve the skills needed during these difficult times.

The researchers would also like to highlight the need for emotional and professional

support as well as institutional support for medical professionals. With our country’s current

healthcare system, professional grief management, such as counselling, debriefing and emotional

support from supervisors and co-workers after patients’ death, is barely available even though it is

very much needed to understand support our medical professionals in their emotionally and

mentally taxing work.

Recommendations

These findings have helped the researchers know more about the variables and the

interactions of each variable with each other. Nonetheless, it is important to consider some

recommendations from the researchers to improve the study and to have more generalizable

results. Regarding the study’s methodology, the researchers recommend that future researchers

make use of a bigger sample size to increase the reliability and external validity. A larger sample

size is also recommended for it will yield a more appropriate representative of the population of

medical professionals as well as the chance of obtaining stronger correlations. An equally

distributed sample in terms of their demographics (age, gender, profession, and location) is at the

least recommended should a larger sample size could not be met in order to maintain internal

validity. This is highly recommended especially to those who plan on conducting comparative

analyses.

In terms of data gathering, the researchers recommend having a more standardized

qualitative measuring to eliminate biases and errors that may result from the differences in the

procedures. In addition, the researchers also recommend an alternative scale measurement to the

Hogan Grief Reaction Checklist that measures the same construct but more focused on traumatic

or complicated grief that is caused by bereavement and loss. Using local scales of measurement

that’s more fitting for Filipino medical professionals is recommended as well. Although previous

studies have suggested the reliability of the foreign scales used, it would be helpful if this study’s

results and findings could be compared to a research that used local scales and find out if studies

that use local scales provide more culturally valid results.

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APPENDICES

Appendix A: Institutional Approval Letter

University of the Philippines

Diliman- Extension Program in Pampanga

FOR:

FROM

SUBJECT:

DATE ISSUED:

Warmest Greetings!

We are fourth year BA in Applied Psychology students from the University of the Philippines

Diliman Extension Program in Pampanga. We are currently conducting a research entitled: Grief

in Profession : A study on Self-compassion, Meaning-making, and Grief Reactions of Medical

Professionals in response to Patient Death. In line with this, we would like to ask for your

assistance in letting us conduct our research in your institution. We are more than willing to follow

your protocols.

The researchers aim to gather at least 100 medical professionals for this study. We wish to

administer a survey for our research in your institution to any of the following professionals in

your institution (preferably but not limited to those assigned to the Intensive Care Unit (ICU)

department):

1. Doctors (generalist and/or specialist medical practitioners)

2. Nursing professionals

3. Residents, interns, and student doctors

This study is being conducted to address the issue of grief amongst medical professionals’ in

response to patient death and understand the different variables behind their grief reactions. The

researchers aim to gather at least 100 medical professionals who have experienced a death of a

patient under their care. The participants will come from different institutions.

Minimal risks may be expected by the participants considering that the scales administration and

interviews contain questions that may trigger or create anxiety or emotional disturbance since

topics are personal and sensitive especially pertaining to death and grief. Participants will not

directly benefit from participating in this study. However, indirect benefits will include the

promotion of our understanding of what factors influence the emotional reactions and to bring

significant contribution and help in addressing the well-being of medical professionals.

If possible, we would like to hold our data gathering from February 9-23, 2019. Specific dates and

schedule will be discussed further, if you will be approving our request, for we are still having our

regular classes from Tuesdays to Fridays (8:30 am- 4:00 pm).

We, the researchers, would like to ensure that all information provided will be kept in utmost

confidentiality and would be used only for academic purposes. The names of the respondents and

the name of the hospital will not appear in any publications unless agreed to. The academic paper,

however, will become an intellectual property of the university once submitted. A copy of the final

paper will be gladly furnished upon request. If you agree, kindly sign below acknowledging your

consent and permission for us to conduct our study/survey at your institution.

We hope you can entertain our request and allow us to complete our requirements to graduate. For

concerns, inquiries, or questions, please contact us through 0999 993 2396 (Smart) or 0916 651

5857 (Globe) or email us at admacapagal1@up.edu.ph or csramirez@up.edu.ph.

Hoping for your kind and favorable response. Thank you very much.

Sincerely,

Angeli Gwyneth Macapagal Czyr Vielca S. Ramirez

Noted by:

Professor Bryan Q. Engay

Thesis Adviser

Approved by:

________________________________ __________________________

Printed Name and Title Signature

Appendix B: Informed Consent Form

University of the Philippines Diliman Extension Program in Pampanga

Bachelor of Arts in Applied Psychology

Informed Consent

Researchers:

Macapagal, Angeli Gwyneth (+63 999 993 2396 / admacapagal1@up.edu.ph)

Ramirez, Czyr Vielca (+63 916 651 5857 / csramirez@up.edu.ph)

Dear respondent:

We, Angeli Gwyneth Macapagal and Czyr Vielca Ramirez, are fourth year BA in Applied Psychology

students from the University of the Philippines Diliman Extension Program in Pampanga taking up the

course, Applied Psychology 199.2: Research in Applied Psychology II. We are currently conducting a

research entitled: Grief in Profession – A study on Self-compassion, Meaning-making, and Grief

Reactions of Medical Professionals in response to Patient Death.

What is this study about?

This study is being conducted to address the issue of grief amongst medical professionals’ in response to

patient death and understand the different variables behind their grief reactions. The researchers aim to

gather at least 100 medical professionals, preferably but not limited to those assigned to the Intensive Care

Unit (ICU) department - doctors (generalist and/ or specialists, residents, interns, student doctors) and

nursing professionals are needed to participate in this study.

What you will be asked to do?

The medical professionals who will volunteer to participate in this study will be answering three (3) sets of

scales - Hogan Grief Reaction Checklist, Self-Compassion Scale - Short Form, and Grief and Meaning

Reconstruction Inventory, that will measure the variables we intend to explore in this study. Answering

each scale may last for 5-10 minutes. Please take the following tests seriously – read and follow instructions

carefully and make sure that all items are answered as your answers will determine the final outcome of

this research. Please do not feel intimidated as there are no right or wrong answers.

After these, you may be asked to participate in an interview if your score fits the criteria of the researchers.

Those who will be chosen will participate in a recorded interview that will contain questions following-up

on the answers on the abovementioned scales and questions exploring the medical professionals’ personal

experiences, grief reactions, and coping strategies. The interview may last for 30-45 minutes. The interview

will take place in a private setting or place that is most accessible to the participant and will be based on

their preferred time.

Risks and benefits

Minimal risks may be expected by the participants considering that the scales administration and interviews

contain questions that may trigger or create anxiety or emotional disturbance since topics are personal and

sensitive especially pertaining to death and grief. If you feel uncomfortable and disturbed by the data

gathering procedure, you are advised to withdraw immediately. You will not directly benefit from

participating in this study. You will not be paid for this study, but the information you provide will be

helpful to the whole community of medical professionals. Indirect benefits will include the promotion of

our understanding of what factors influence your emotional reactions. Also, the answers you will give

would bring significant contribution and help in addressing the well-being of medical professionals.

Your participation is voluntary

Taking part in this study is completely voluntary. Not participating or choosing to leave the study will not

results in any penalty of loss of any benefits you would otherwise receive. If you feel uncomfortable, you

may refuse to answer any of the questions.

Your answers to questions will be confidential

The researchers will maintain confidentiality and care of the information gathered through this study as far

as possible. The data gathered would be used only for academic purposes. The names of the respondents

and the name of the hospital will not appear in any publications unless agreed to. The academic paper,

however, will become an intellectual property of the university once submitted. A copy of the final paper

will be gladly furnished upon request.

Thank you very much for taking part in this research.

Sincerely,

Macapagal, Angeli Gwyneth Ramirez, Czyr Vielca

Researcher Researcher

Noted by:

Professor Bryan Q. Engay

Thesis Adviser

______________________________________________________________________________

I, ______________________________________, do hereby agree to be a respondent in the data gathering

for a thesis entitled Grief in Profession – A study on Self-compassion, Meaning-making, and Grief Reactions of

Medical Professionals in response to Patient Death. I understand clearly the procedures and purpose of the study. I

was informed about the need of the study that it will help in providing information about experiences of medical

professionals. I am fully aware that I will be asked questions that revolve around my experience as a medical

professional. Anytime I feel uncomfortable, I can withdraw my participation from this study. To help in the success

of this study, I will do the best that I can to answer the questions as honestly as I can. I have been told that my answers

will be kept confidential and will only be used for the purpose of this study. I am aware that the interview that will be

conducted will be recorded through the use of an audio recorder for documentation purposes. I am also aware that the

results of this study may be available to me upon my request. The researchers may reach me by contacting

____________________.

I understood everything I have read. I will follow the guidelines that this study provides.

____________________________________ _________________________

Signature over Printed Name of Respondent Date Signed

Appendix C: Hogan Grief Reactions Checklist

Name: _________________________________ Age: ______ Contact No.: _________________

Sex: ☐ M ☐ F Profession: ______________________ Years of professional experience: _____

Number of deaths (under your care) encountered in your career: ☐ 1-5 ☐ 6-10 ☐ 11-20 ☐ >20

I. This questionnaire consists of a list of thoughts and feelings that you may have had because of the death

of a patient, that has been most difficult for you. Please read each statement carefully and choose the

number that best describes the way you have felt because of it. Write the number on the blank beside the

statement that best describes you. Please do not skip any items.

1 Does not describe me at all 3 Describes me fairly well 5 Describes me very well

2 Does not quite describe me 4 Describes me well

1. My hopes are shattered

1 2 3 4 5

Despair

2. I have learned to cope better with life

1 2 3 4 5

Growth

3. I have little control over my sadness

1 2 3 4 5

Despair

4. I worry excessively

1 2 3 4 5

Panic

5. I frequently feel bitter

1 2 3 4 5

Blame/Anger

6. I feel like I am in shock

1 2 3 4 5

Despair

7. Sometimes my heart beats faster than it

normally does for no reason

1 2 3 4 5

Panic

8. I am resentful

1 2 3 4 5

Blame/Anger

9. I am preoccupied with feeling worthless

1 2 3 4 5

Detachment

10. I feel as though I am a better person

1 2 3 4 5

Growth

11. I believe I should have died and he or she

should have lived

1 2 3 4 5

Despair

12. I have a better outlook on life

1 2 3 4 5

Growth

13. I often have headaches

1 2 3 4 5

Panic

14. I feel a heaviness in my heart

1 2 3 4 5

Despair

15. I feel revengeful

1 2 3 4 5

Blame/Anger

16. I have a burning in my stomach

1 2 3 4 5

Panic

17. I want to die to be with him or her

1 2 3 4 5

Despair

18. I frequently have muscle tension

1 2 3 4 5

Panic

19. I have more compassion for others

1 2 3 4 5

Growth

20. I forget things easily (e.g., names, phone nos.)

1 2 3 4 5

Disorganization

21. I feel shaky

1 2 3 4 5

Panic

22. I am confused about who I am

1 2 3 4 5

Detachment

23. I have lost my confidence

1 2 3 4 5

Detachment

24. I am stronger because of the grief I have

experienced

1 2 3 4 5

Growth

25. I don’t believe I will ever be happy again

1 2 3 4 5

Despair

26. I get angry often

1 2 3 4 5

Blame/Anger

27. I have difficulty remembering things

from the past

1 2 3 4 5

Disorganization

28. I frequently feel frightened

1 2 3 4 5

Panic

29. I feel unable to cope

1 2 3 4 5

Detachment

30. I agonize over his or her death

1 2 3 4 5

Despair

31. I am a more forgiving person

1 2 3 4 5

Growth

32. I have panic attacks over nothing

1 2 3 4 5

Panic

33. I have difficulty concentrating

1 2 3 4 5

Disorganization

34. I feel like I am walking in my sleep

1 2 3 4 5

Despair

35. I have shortness of breath

1 2 3 4 5

Panic

36. I avoid tenderness

1 2 3 4 5

Detachment

37. I am more tolerant of myself

1 2 3 4 5

Growth

38. I have hostile feelings

1 2 3 4 5

Blame/Anger

39. I am experiencing periods of dizziness

1 2 3 4 5

Panic

40. I have difficulty learning new things

1 2 3 4 5

Disorganization

41. I have difficulty accepting the

permanence of the death

1 2 3 4 5

Despair

42. I am more tolerant of others

1 2 3 4 5

Growth

43. I blame others

1 2 3 4 5

Blame/Anger

44. I feel like I don’t know myself

1 2 3 4 5

Detachment

45. I am frequently fatigued

1 2 3 4 5

Panic

46. I have hope for the future

1 2 3 4 5

Growth

47. I have difficulty with abstract thinking

1 2 3 4 5

Disorganization

48. I feel hopeless

1 2 3 4 5

Despair

49. I want to harm others

1 2 3 4 5

Blame/Anger

50. I have difficulty remembering new

information

1 2 3 4 5

Disorganization

51, I feel sick more often

1 2 3 4 5

Panic

52. I reached a turning point where I began

to let go of some of my grief

1 2 3 4 5

Growth

53. I often have back pain

1 2 3 4 5

Panic

54. I am afraid that I will lose control

1 2 3 4 5

Detachment

55. I feel detached from others

1 2 3 4 5

Detachment

56. I frequently cry

1 2 3 4 5

Despair

57. I startle easily

1 2 3 4 5

Panic

58. Tasks seem insurmountable

1 2 3 4 5

Disorganization

59. I ache with loneliness

1 2 3 4 5

Despair

60. I am having more good days than bad

1 2 3 4 5

Growth

61. I care more deeply for others

1 2 3 4 5

Growth

Appendix D: Self-Compassion Scale - Short Form

II. Please read each statement carefully before answering. Draw a check (✔) for each statement

based on how often you behave in the stated manner (Almost Never—Almost Always). There are

no correct or wrong responses. Please be aware that your answers will remain confidential and will

be used for academic purposes only.

HOW I TYPICALLY ACT TOWARDS MYSELF IN DIFFICULT TIMES

Almost

never

Seldom

Sometimes

Often

Almost

Always

1. When I fail at something important to me I

become consumed by feelings of inadequacy.

2. I try to be understanding and patient towards

those aspects of my personality I don’t like.

3. When something painful happens I try to take a

balanced view of the situation.

4. When I’m feeling down, I tend to feel like most

people are probably happier than I am.

5. I try to see my failings as part of the human

condition.

6. When I’m going through a very hard time, I give

myself the caring and tenderness I need.

7. When something upsets me, I try to keep my

emotions in balance.

8. When I fail at something that’s important to me,

I tend to feel alone in my failure

9. When I’m feeling down, I tend to obsess and

fixate on everything that’s wrong.

10. When I feel inadequate in some way, I try to

remind myself that feelings of inadequacy.

11. I’m disapproving and judgmental about my own

flaws and inadequacies.

12. I’m intolerant and impatient towards those

aspects of my personality I don’t like.

Appendix E: Meaning-making Scales - GMRI and Single-item questions

III. The following statements referred to as thought, beliefs, feelings, and meanings some bereaved

people experience following their loss. Draw a check (✔) on the box that rates the degree

(Strongly Disagree—Strongly Agree) to which each of these experiences has been true for you.

Strongly

Disagree

Neither

Agree

Strongly

Agree

1. I do not see any good that has come from this loss.

2. Since this loss, I’m more self-reflective.

3. I was prepared for my (patient) to die.

4. I’ve lost my innocence.

5. Since this loss, I have changed my lifestyle for the

better.

6. I feel pain from regrets I have in regard to loss.

7. I can’t understand this loss.

8. Since this loss, I am now for more responsible person.

9. My (patient) was ready to die.

10. Since this loss, I’ve pursued new avenues of

knowledge and learning.

11. This death brought my (patient) peace.

12. Since this loss, I feel like I am a stronger person.

13. This death ended my (patient’s) suffering.

14. Since this loss, I make more effort to help others.

15. Since this loss, I find myself more alone and isolated.

16. I feel empty and lost.

17. Since this loss, I value friendship and support more.

18. I’ve been able to make sense of this loss.

Factor Item #’s

Personal Growth 2, 5, 8, 10, 12, 14, 17

Sense of Peace 3, 9, 11, 13, 18

Emptiness & Meaninglessness 1, 4, 6, 7, 15, 16

Appendix F: Interview Protocol

Script

Welcome and thank you for your participation today. We are AG Macapagal and Vielca Ramirez

and we are graduating students of University of the Philippines Diliman Extension Program in Pampanga

conducting our thesis in partial fulfillment of the requirements for the degree of BA in Applied Psychology.

First, thank you for completing the surveys and especially for agreeing to help us with this study. This

follow-up interview will take about 60 minutes and will include questions regarding your experiences as a

medical professional and what might affect your grief reactions in response to the death of your patients.

Before we start, we’d like to ask for your written consent to participate in this study. As written in

your informed consent form, your participation is entirely voluntary. This study will involve minimal risk

and discomfort. The probability of harm and discomfort will not be greater than your daily life encounters.

Risks may include emotional discomfort from answering the interview questions. If at any time during the

interview you wish to discontinue the interview itself, please feel free to let us know. Also, we would like

your permission to voice record this interview, so we may accurately document the information you convey.

Your responses will remain confidential and only aggregated data will be used in our research study. You

will not directly benefit from participating in this study. Indirect benefits will include the promotion of our

understanding of what factors influence the emotional reactions and to bring significant contribution and

help in addressing the well-being of medical professionals.

Once again, your participation in this interview is completely voluntary. If at any time you need to

stop, take a break, or return a page, please let us know. You may also withdraw your participation at any

time without consequence. Do you have any questions or concerns? If there are none, can you tell me a

little bit about yourself before we jump into specific research questions?

Questions

Demographics

Can you tell me a little bit about yourself?

(Doctors and Nurses) When did you receive your license and how long have you been practicing?

(Interns and Clerks) How long have you been an intern?

In which institution/hospital are you currently working/interning in? Public/private?

Perception of Self as a Doctor/Intern

How do you see yourself as a doctor/intern?

How does it feel to be a doctor/intern?

What do you think a doctor/intern's main purpose is?

What is the most difficult aspect of being a medical professional?

Patient Death (Experiences, reactions, coping strategies and effects)

Have you ever experienced a death of a patient under your care?

If yes, how many have you encountered (approximately)?

Would you be willing to share your memories of your first or most memorable patient death?

Can you describe the circumstances surrounding the incident (if more than one, in general)?

What did you feel during the experience?

What did you feel after the experience?

What did you do after what happened?

How did you cope with what had happened?

Since the incident (if more than one, think of the most recent), has any of the following been affected:

- Your motivation to go to work

- The way you treat your other patients

- Your level of attachment with your patients

- Your confidence as a doctor

If yes, in what ways has/have this/these been affected? If no, why do you think not?

Self-compassion

(Mention their score in the Self-Compassion Scale by Kristin Neff and ask them about their

experience while answering it)

How do you balance your emotions and your responsibilities of being a medical professional,

particularly regarding a dying patient or a death?

Meaning-making

“How much sense would you say you have made of the loss?”

Rate using 5-point Likert-type scale, 1 (I have been able to make no sense of my loss) to 5 (I have

made a great deal of sense of my loss)

“Despite your loss, have you been able to find any benefit from your experience of the loss?”

Rate using a 5-point Likert-type scale, 1 (no benefit) to 5 being (great benefit)

Overall, do you believe that you have changed as a person since you first experienced the unexpected death

of a patient? If yes, in what ways? Do you have anything else you wish to add on?

Closing

That would be my last question for you, thanks very much for taking the time to talk with me and for your

contribution to our study, it’s much appreciated. Before we wrap things up and talk about next steps, do

you have any questions for me or are there any last comments you have regarding this area of research?

Appendix G: Raw Scores of the Participants

HGRC

SCS-SF

GMRI

P1 - CC

2.96

2.67

2.28

P2 - CC

1.29

2.67

3.39

P3 - CC

1.53

3.50

3.44

P4 - CC

1.65

2.67

2.89

P5 - CC

1.73

3.58

3.61

P6 - CC

3.00

2.83

3.56

P7 -CC

2.00

2.83

3.06

P8 - MP

1.41

4.00

P9 - MP

1.61

3.00

3.22

P10 - MP

2.12

3.75

3.44

P11 - MP

2.82

2.83

3.00

P12 -MP

1.00

3.00

2.83

P13 - MP

1.00

3.42

3.67

P14 - MP

1.24

2.92

4.00

P15 - MP

1.31

3.58

3.61

P16 - MP

1.35

3.33

3.78

P17 - MP

1.37

3.75

4.00

P18 - MP

1.55

3.83

2.89

P19 - MP

1.63

2.92

3.28

P20 - MP

1.69

2.17

3.89

P21 - MP

1.92

3.17

3.28

P22 - MP

2.00

3.17

3.56

P23 - MP

2.20

3.08

3.44

P24 - MP

2.22

3.58

3.50

P25 - MP

2.35

2.83

3.33

P26 - MP

2.57

3.08

2.94

P27 - MP

1.08

3.83

3.61

P28 - MP

1.10

2.75

3.33

P29 - MP

1.22

3.25

2.89

P30 - MP

1.24

2.92

3.06

HGRC

SCS-SF

GMRI

P31 - MP

1.27

3.25

2.83

P32 - MP

1.33

3.58

3.94

P33 - MP

1.35

3.25

3.44

P34 - MP

1.45

3.08

3.39

P35 - MP

1.61

3.50

3.22

P36 - MP

1.69

3.17

3.67

P37 - MP

2.80

3.33

2.78

P38 - MP

1.20

3.33

3.28

P39 - MP

1.27

2.67

4.00

P40 - MP

1.08

3.83

3.78

P41 - MP

1.20

3.92

4.28

P42 - MP

1.29

3.42

3.89

P43 - MP

1.45

3.25

3.72

P44 - MP

1.65

3.25

3.17

P45 - MP

1.67

3.00

3.56

P46 - MP

1.76

2.58

3.22

P47 - MP

1.84

3.50

4.11

P48 - MP

1.94

3.25

3.11

P49 - MP

2.63

2.75

2.94

P50 - NP

1.29

3.08

2.83

P51 - NP

1.16

3.50

4.00

P52 - NP

1.20

3.58

3.78

P53 - NP

1.47

3.42

4.00

P54 - NP

1.69

3.33

3.44

P55 - NP

1.76

3.42

3.61

P56 - NP

1.78

3.75

3.11

P57 - NP

1.86

3.08

4.06

P58 - NP

1.92

3.33

4.00

P59 - NP

2.04

3.33

3.56

P60 - NP

2.06

3.50

3.39

HGRC

SCS-SF

GMRI

P61 - NP

2.08

3.33

3.39

P62 - NP

2.10

3.25

3.78

P63 - NP

2.12

3.50

P64 - NP

2.20

2.92

3.11

P65 - NP

2.49

3.50

3.72

P66 - NP

2.73

3.33

3.17

P67 - NP

2.78

3.58

3.44

P68 - NP

3.12

3.25

2.83

P69 - NP

3.16

2.83

P70 - NP

3.18

3.25

2.89

P71 - NP

1.14

3.58

2.44

P72 - NP

1.16

3.33

3.50

P73 - NP

1.20

3.50

3.61

P74 - NP

1.33

3.58

3.17

P75 - NP

1.39

3.33

3.72

P76 - NP

1.55

3.67

3.33

P77 - NP

1.73

3.33

3.44

P78 - NP

1.90

3.50

4.00

P79 - NP

2.00

2.92

3.00

P80 - NP

2.06

3.42

2.83

P81 - NP

2.18

3.67

3.61

P82 - NP

2.65

3.42

3.28

P83 - NP

3.76

3.33

3.56

P84 - NP

1.16

3.50

P85 - NP

1.18

3.58

3.89

P86 - NP

1.35

3.58

3.94

P87 - NP

1.69

3.75

4.28

P88 - NP

1.94

3.17

3.28

HGRC

SCS-SF

GMRI

P89 - NP

2.14

3.42

3.39

P90 - NP

2.63

3.58

3.22

P91 - NP

3.20

2.67

3.17

P92 - NP

3.94

3.08

3.28

P93 - NP

1.08

3.17

3.11

P94 - NP

1.12

3.33

3.39

P95 - NP

1.14

3.67

3.33

P96 - NP

1.41

3.00

3.56

P97 - NP

1.59

3.42

3.61

P98 - NP

1.73

3.00

3.17

P99 - NP

1.78

3.00

3.33

P100 - NP

1.86

3.75

3.56

P101 - NP

2.12

3.17

3.28

P102 - NP

2.94

2.92

2.67

P103 - NP

3.55

2.75

3.67

P104 - PGI

1.10

3.08

2.89

P105 - PGI

2.27

2.50

3.22

P106 - PGI

2.37

3.25

3.67

P107 - PGI

2.63

2.92

3.17

P108 - PGI

1.06

3.33

3.50

P109 - PGI

1.61

3.33

4.00

P110 - PGI

2.10

3.33

3.22

P111 - PGI

3.65

2.92

3.89

P112 - PGI

4.16

3.50

3.22

P113 - PGI

1.22

3.50

3.44

P114 - PGI

2.10

3.83

3.28

P115 - PGI

3.45

2.67

2.33

Note: The numbers under the columns of HGRC, SCS-SF, and GMRI contain the mean scores of each

participant for the corresponding scale instrument.

Appendix H: Interview Transcriptions

H1.

Participant 14 (41, Male, Pampanga)

Medical Practitioner (Internal Medicine)

Years in profession: > 15 years

No. of Patient Deaths: > 20

HGRC Score: 1.24 (Low)

SCS-SF Score: 2.92

GMRI Score: 4.00

Participant: So nanu ya ing thesis mu? About nanu ya?

R: About grief in profession po in response to patient death.

Participant: Okay. So you’re trying to determine if it affects the healthcare professional, makanyan

ba ita?

R: Yes, what we’re trying to determine po is if it’s true that healthccare professionals do experience

grief when it comes to the death of their patients.

Participant: Ahh grief, okay. Yes, Of course, I mean, kayi naku, 21 years naku kening field ayni,

pero I still get affected everytime. Especially, syempre makarelate ka, balamu ika itang

malalakwan eh. Especially patse anak la? Patse pediatrics la?

R: Opo, so before we start, can you tell me a little bit about yourself and your work as a medical

professional?

Participant: I’m a medical practitioner specializing in pulmonary medicine kening hospital, critical

care department so mostly we deal with patients who are already on life support, maka ventilators

and respirators. We deal with a lot of end-of-life situations, ranging from neonatal to adult. Like

the other day, I was at work and I had to take to people off life support. So kalako na ning life

support tambing lang... mamamate nala after, afterwards.

R: How did you get po into this profession? What is the reason that your pursued this particular

line of work?

Participant: Well actually, I started as a Physical Therapist but I found it boring kasi ala lang kayi

bala mu itang king critical care makanta? Bu then I found this other field, sabi ko “ahh they get

more involved in like intensive care”, I became interested then yun pinursue ko yung pulmonary

medicine then 20 years after I’m still here.

R: So yung parang pinaka area of practice niyo po is critical care?

Participant: Uh kayi, critical care that ranges from care for pediatric patients to adults.

R: Okay so next question naman po, how do you see yourself as a medical professional?

Participant: Ah, I see myself as someone whose able to help people and that makes me feel good.

I get to make a difference.

R: What are the best aspects naman of being a medical professional?

Participant: To be able to help people and make a difference in people’s lives, I mean despite of

the people that we lose, I mean we save a lot of people. So, it makes up for the losses that we have.

Even with that were still not immune to the loses, because you’re just human, you still feel it.

R: What about the most difficult aspects? Would you say that losing people is one of them?

Participant: Most difficult aspects? In working in the Medical Field?

R: Yes po.

Participant: Of course, but aside from that, one that’s more difficult is feeling bad for the people

who are left behind.

R: What do you mean by “left behind”?

Participant: Like when you lose somebody? I don’t feel bad for them because they’re at peace. I

feel bad for the people that are left behind.

R: So, about patient death naman po. On average how many patient deaths do you deal with on a

weekly basis?

Participant: How many patients die?

R: Opo, if not weekly po, monthly ganon.

Participant: If weekly, mga 1 or 2 a week. Or actually, mga around 10 patients maybe a month.

R: Next question po, I want you to think of one patient who died that was particularly difficult for

you. Can you describe the patient?

Participant: Uh, Pediatric patient, 4-year-old kid.

R: When did this happen?

Participant: Siguro mga three years ago.

R: Can you describe the patient? Like kung ano po yung sakit niya nun, why was it difficult?

Participant: Actually, ganon lagi ako kapag pediatric patients eh. It’s difficult kasi they never

experienced life yet, they’re so innocent, like they haven’t lived their life? And they already lost

their life. It’s different from losing a 90-year-old patient who lived their life already.

R: Do you remember po why that kid died?

Participant: This kid has end stage cancer, 4 years old. And was the only child. Actually, the

parents were both Medical Professionals, her mom was a pharmacist. They had to put the kid on

life support, he was on life support for maybe a few weeks? After a while, it was determined that

there’s nothing more we can do to treat the child, basically the child was just suffering on life

support. But he wasn’t gonna get any better. So the family decided to withdraw the care, to make

him comfortable and to stop all the treatments that we were doing.

R: So would you say na medyo matagal tagal din po yung relationship niyo with the patient, since

weeks po siyang on life support?

Participant: Oh yeah for like a few weeks, maybe a couple of weeks.

R: So nung tinanggal na po yung life support, what did you feel during the experience?

Participant: What I felt was like a contradiction actually, at first, of course I felt sad because it’s a

small child. And I feel bad for the parents that were left behind because that was the only child

that they had. At the same time, I felt relieved because hindi na siya mag-suffer, he’s not gonna go

through suffering anymore. Because in the end, he’s not gonna get any better. So, he’s just

basically living his last days of his life suffering with all these tubes inserted into him.

R: What about after the experience naman po? What did you feel?

Participant: I mean I learned to appreciate life more. Cause you know that it can end anytime.

R: Did you do anything to cope with what had happened po?

Participant: Actually, in our hospital they can provide us with grief counseling? If we need to, but

I really haven’t gone through any grief counseling. Cause I just rationalize it like initially like

when I was a new? Doing this in this field. I used to get bothered, and it used to take days to

recover, but now like I said before what I feel, it’s a contradiction, because at the same time I’m

relieved that the patient or the kid doesn’t have to suffer anymore.

R: So, would you say na yung factor that made this death more difficult than the others is the fact

that he’s still very young?

Participant: Sort of like I think it was hard for me or like I remember this death the most kasi kayi

pin eh, nang awus kanine, it affected me. I was able to relate to them because I only have 1 child.

So sabi ko, If I have one child and this happened to my child, imagine the feeling that I’ll be

having. I was able to relate a little bit more because I also have one child, I can’t imagine going

through something like that.

R: So, how much grief would you say have you experienced over that patient?

Participant: How much grief? Siguro I did but not so much. Of course, I mean you know, like I

said that’s a four-year-old kid that hasn’t even lived his life yet. I mean for him to lose it at that

young age, I mean any human being will surely be affected by that.

R: For how long did that grief last?

Participant: I still think about it every now and then. Every time I look at a kid, every time I look

at my own kid, I think about that.

R: So other than that, may types of grief po ba kayo na na-experience, like did you feel down often,

had trouble sleeping, crying?

Participant: Sometimes like when you feel like you could’ve done a little bit more. It bothers you,

you start thinking about it. But you know, after a while you’ll be able to cope but you’d still think

about it, you know like you ask yourself had you done something different, would it make a

difference?

R: You talked about learning how to cope, are there particular things that you do, like talk to your

peers, your family?

Participant: Yeah, that helps, talking to co-workers, talking to colleagues, that usually helps.

R: So next question po, did this loss of a patient affect you emotionally?

Participant: Yes

R: Why do you say so?

Participant: Well, I didn’t think that I was the sensitive type of person that, but I seem to have

gotten affected by this and learned to appreciate life more.

R: What about professionally naman po?

Participant: Professionally, I’m more compassionate. I’m more caring as opposed to, when I was

younger, 20 years ago, I wasn’t you know, I wasn’t as compassionate as I am now.

R: Did something change the way you treat your other patients after the incident?

Participant: Yes, ever since I started experiencing patient deaths, I tried to communicate with them

more, I tried to make them feel at peace. Sometimes all they need is like a laugh? Like a

joke? Sometimes that makes a difference. But not all the time though, kayi pin diba in our

department, critical care, we have patients that aren’t awake at all. So the ones that are awake, I

try to make them somewhat a little bit better.

R: What about your level of attachment to your patients?

Participant: So, like I said earlier I deal with critical care. So, you really don’t get to attached kase

after they get better, they get moved somewhere else.

R: Next naman po. About self-compassion, the ability to be compassionate to oneself especially

during difficult times. For my question po, what is the role of compassion when it comes to dealing

with patients?

Participant: Well, I think it helps you learn how to relate, like you’re in that position yourself. So,

obviously you’re gonna try your best, or even go beyond to try and see if you can make a

difference. I mean, cause after a while, you don’t only feel bad for the patient but you’ll feel bad

for the family members.

R: What about, are there times that you feel bad or like question yourself? Your abilities?

Participant: Of course, I mean, that’s almost like every time, every time you ask if there’s

something different that I could’ve done to make a difference.

R: Opo. How often has that happened to you?

Participant: All the time, I mean you know, you always think “could I have done something

different?”. “Next time this happens, is there any way that I can change to make a difference?”

like all the time.

R: So whenever that happens, how do you balance your emotions and your responsibilities as a

medical professional?

Participant: Hmmm siguro kalupa na pin ning sinabi ku nandin, despite the losses we still get to

save people. So even if we lose 10 people a month, we also save a hundred people a month. So, if

we go by statistics, were still good. I guess that helps us in coping kase we lose some, but we save

a bit more than we lose. I just think that you can’t save everyone so you just have to do what you

can.

R: Ohh so, let’s go to meaning making naman po, on a scale of 1-5, how much sense would you

have made of the loss?

Participant: On a scale of 1-5? Bakit nangyari yung event nay un?

R: Parang, how much sense does it make na may nangyari pong event na ganon? Parang, yung

iniisip po ng mind niyo na may reason kung bakit nangyari yun, and you make sense of the event

like it’s something good, ganon po.

Participant: Ahh okay, siguro 4 out of 5.

R: Okay po. Next po is despite the loss, have you been able to find any benefits from the

experience? On a scale of 1-5 rin po.

Participant: Siguro 4 out of 5 din kasi, I mean, you learn to look at life at a different perspective,

you learn to enjoy every minute, I mean cause life can be taken from you any minute, any second.

You learn to appreciate the little things more.

R: So overall, do you believe that you have changed as a person since those experiences of patient

deaths? In general.

Participant: That I learned as a person? That I grew as a person?

R: Opo.

Participant: Yes, absolutely.

R: In what ways?

Participant: It made me more patient, it made me more compassionate, it made me appreciate life

more, it made me more caring, it made me more sensitive as a person.

R: Last question po, is there anything else you’d like to share?

Participant: Anything that what?

R: That you like to share po about your experience as a Medical Professional. Aside from

everything you’ve mention a while ago.

Participant: Hmm yes. When you become a medical professional, your outlook in life changes

once you’re in the profession. Like for example, my Dad is sick right? --- we just found out he’s

got cancer, but we know he’s not gonna get any better right? Alang panulu keng disease na. So

sabi mi, instead of like treating it when the outcome is not gonna be good, why don’t we just not

tell him and just leave him to live the rest of his life. Be happy, instead of being depressed when

he’s not gonna get any better. I mean working in the Medical Profession, you start thinking about

that, because if you don’t have any medical background, of course you would go for every

treatment, you know? Andyang you know the outcome is not gonna be good, you will go for a

treatment till the end. So being in the Medical Profession you can appreciate more, like you can

say “Oh you know I’m not gonna get any better”, It’s quality of life over quantity of life. So instead

of like getting treatments for 2 years then being in the hospital for the whole 2 years and still dying

after 2 years, why don’t I just enjoy the rest of my 2 years? And not worry about anything?

R: Oo nga po. Do you think it depends on every person parin po ba?

Participant: Yes, but to be honest majority of the people that have been doing this for a long time

feel the same way. I mean it depends on how you’ve been in this field. I mean the new people have

a different outlook, but the people that have experience that have been doing this for a long time

have a different outlook.

H2.

Participant 47 (30, Female, Metro Manila)

Medical Practitioner (General Practice)

Years in profession: Less than 1 year

No. of Patient Deaths: 6-10

HGRC Score: 1.76 (Ave)

SCS-SF Score: 2.58

GMRI Score: 3.22

R: Good afternoon po!

Participant: Hello.

R: Okay lang po ba na ma-interview ko po kayo for thesis?

Participant: Okay sige, sige lang.

R: Let’s start na po?

Participant: Oo, sige.

R: Can you tell me a little bit about yourself before we jump into specific research questions?

Participant: May specific questions ba for this?

R: Opo, later po, about your experience. So can you tell me a little bit about yourself?

Participant: Ah.. open question lang ba yan?

R: Opo.

Participant: Okay, I’m 30 years old, married, with 3 children. I just passed the medical board last

September 2018. Tapos currently I am working as a physician sa different clinics in Manila.

R: Can you tell me about your typical day at work?

Participant: Oh okay, so right now, it’s more of an OPD Cases, yung mga nagpapaconsult, like

cough, colds. Yung mga nagpapapre-employment Physical Examination and Medical Evaluation.

So, it’s mostly an 8- 5pm office job, and I see patients in the clinic. So iba iba yung cases.

R: Okay, namention niyo nga pala na kakapasa niyo lang po ng board, may plans na po ba kayo

na magspecialize?

Participant: Baka next year kase yearly lang kase yun eh.

R: Oh, how do you see yourself as a doctor naman po?

Participant: How I see myself… personally I think… compared to you know… since kakastart

lang, I really try to spend time talking to the patients, as much as possible I try to treat them not

just as cases, but more of as people. So, I really spend time with them, to talk to them, to counsel

them, kung ano man yung naffeel nila and kung kamusta sila… not just how they’re doing sa

physical well-being, but also sa psychological aspect.

R: What are some of the best aspects of being a doctor?

Participant: It’s actually more of a being able to reach out to people, and how they see you in a

different light, parang they see you in a regarded person in the society, and it’s very rewarding

since nakakatulong ka talaga ng mga tao and nakikita mo talaga that Nakita mo yung gratitude nila

kapag natulungan mo sila.

R: Sa public or private po ba kayo nagpapractice?

Participant: Ngayon sa private.

R: Pero naexperience niyo po bas a public before?

Participant: Oo, sa internship kase namin is iba iba. Pag nagrrotations na, it’s a combination of

private and public. Yung usual for example kapag pedia, meron kaming rotation sa PCMC, sa

pediatric na public. And then kapag ortho naman sa POC naman kame. So iba iba, and then in

internship ganun din, sa Medical City kame for our private. Pero half the time we spend our

internship sa hospital ng Makati, so public rin siya.

R: If there are best aspects po, ano naman po yung most difficult aspects of being a doctor for you?

Participant: I think, I’ll give siguro mga tatlo, So firstly, I would say it’s not really the studying eh,

para sakin ang pinakamahirap is spending a lot of time outside of the house, spending most of the

time at the hospital, well for me yun yung concern ko kase may family nako, so ang hirap for me

to spend 36 hours and then not lean with my family. On top of that, sometimes hindi maiiwasan

na may mga patients na very…. so to speak, parang isip lang nila na sila lang yung priority. Like

hindi kana nga kumain, hindi kana nagbreakfast, naglunch, tapos sila pa magagalit kapag mabagal

uyung service. So maybe that’s one thing na nakakainis. Well I guess it’s the system natin talaga

sa Philippines, iba kase. Then secondly, hindi rin maganda is for sometimes you would

experience… and this is a part of your study, right? Deaths? And sometimes some doctors tend to

blame themselves when some things like that happen.

R: Since namention niyo na din po yung death of patients, on average how many deaths of patients

do you with on a weekly basis? If not weekly, monthly?

Participant: Actually, marami na pero nung training pa yun and not all experiences eh ako yung

naghahandle talaga. So, uhm wait I’ll exclude na rin yung ngayon, mostly ngayon kasi outpatients

nako diba? So, for the past 2 years I would say, personally na ako nakawitness ah. As in I was

there when the patient died mga 20 na siguro.

R: How about under your care?

Participant: Under my care? Kase iba yun eh, kapag under my care parang, I had an interaction

with them, I would say… mga 6?

R: Ohhh. Now, I want you to think of 1 patient who died that was particularly difficult for you.

Pwede niyo po bang idescribe sakin yung patient?

Participant: So, this is a case in ICU, sa hospital ng Makati. So, in this hospital kase yung sa ICU,

its mostly very, yun nga… since it’s an ICU, these are severe cases. So, then ang problem ko sa

hospital ng Makati is that… laging puno. So, some patients, kahit na they have to be transferred to

the ICU, they’re just waiting for a room, they’re just in the ER. This patient is…. I forgot yung

case pero intubated sya sa ICU, and then nagcode kame, we ran the code for siguro about 30

minutes? Tapos narevive… and then after 30 minutes ulit, after ilang minutes ulit, nagcode siya

ulit… And then I remember this one parang when we were trying to revive him ulit… there was

blood coming out of his mouth na, so parang very gruesome na experience for me.

R: When did this happen?

Participant: This was siguro… 2017? Around August.

R: What do you think this patient death more difficult for you than the others po?

Participant: Siguro cause ano, mas bata sya, male sya na nasa parang 30s or 40s palang. So siguro

for me kase, yun yung parang feeling ko kase it’s a waste of life? Na bata palang namatay na siya.

R: Would you say na may relationship po kayo with the patient? Gaano niyo po ba sya katagal

nakasama? How long po siya under you care?

Participant: Siguro mga 2 days lang.

R: Ano po yung nafeel niyo during yung experience na ganon po?

Participant: I was sad and then actually ang mas nakakalungkot na nakita ko yung family niya

biglang pinapasok sa ICU tas nakita nila na nawala yung family member nila, kaya dun yung mas

emotional for me na seeing his family members na di nila matanggap na nawala na yung family

member nila.

R: Did you do anything to cope with what had happened?

Participant: Usually as intern we talked about it, kame kame pinaguusapan naminkung anong

nangyari, and then what could have been done to save that patient.

R: Aside from the factor po na you thought that it was too early para po dun sa patient na yun, may

iba pa po bang factor that made the death more difficult?

Participant: Ibang factors is like saying kase some of the cases could’ve been prevented. Parang

sayang kase sana pumunta siya agad, nagpatingin agad, edi sana natreat siya agad. Yun yung prang

mas nakakapanghinayang.

R: So, would you say po ba na you felt grief over the loss of this patient?

Participant: Actually, I think more of… in the first few times you’ve encountered it, parang dun

mas siya mafefeel na yung impact sayo, but eventually kapag matagal kana parang sad to say,

medyo nasasanay din kame.

R: Were there times that you think of him often? Felt down because of his death?

Participant: Hindi naman.

R: So, Kung ipagsasama po yung experience niyo ng patient deaths, in what way of these

experiences effect you emotionally?

Participant: Emotionally? Siguro parang more of a learning, you take it as a learning experience, I

guess? Na mas maging careful ka next time cause, it makes you more prepared next time eh. It

helps you rin to be more tough, helps you to know how to handle the death the next time it happens.

R: What about professionally naman po? In your experience of patient death, may naging effect

po ba on your like let’s say, motivation to go to work?

Participant: Ah… wala naman. Not to that point na parang gusto ko nang magquit? Hinde.

R: What about the way you treat your other patients po?

Participant: With regard to that, siguro mas you tend to want to spend more time with them.

R: Kung irarate niyo po yung level of attachments niyo with your patient, paano po?

Participant: I would say mga 7-8

R: Why po?

Participant: Of course, once you get to talk to them, deal with them parang mas nagiging.. you get

to know more of them, parang mas naattach ka sakanila or di naman attach. Since attach ka, but

you don’t want to be too attached kase if you become to attach, mahirap sayo when some things

like this happen. And most of time its out of your control, and di mo anman pwedeng sisihin yung

sarili mo.

R: That actually leads to my next question po. Yung isa po kase sa scales na sinagutan niyo po sa

survey namen is about self-compassion. Self-compassion po I like your ability to be compassionate

to yourself especially in times of difficulty, in times of failure ganon po. Yung score niyo po dun

is actually one of the lowest scores. How would you explain this po?

Participant: I would say, siguro kasi… I tend to think of the worst case scenario para kapag hindi

as expected yung naging result hindi ako masyadong down agad.

R: What about in times of failing? Do you see your failings as part of the human condition?

Participant: I sometimes see them as that though not lagi, because I have like an attitude na I tend

to overthink, so everytime na may failure, I tend to overthink about it, and sometimes blame

myself.

R: So kapag ganon naman po, how do you balance your emotions and your responsibilities as a

doctor?

Participant: At first it’s hard to… wala accept molang rin naman talaga na sometimes… actually

medicine is a very humbly experience kase of course hindi lahat ng bagay under your control, and

you realize that there are things na hindi mo alam, so parang it’s a very humble experience and

you get pushed to… like it helps you turn more into the positive side, like looking at the positive

things in a positive light. So yun to balance these two I just take the hardships that come to me as

learning experiences.

R: If yung experience niyo po in patient deaths, how much sense do you think have you made with

these losses?

Participant: Like how much did I give meaning to the losses?

R: Yes po.

Participant: I guess, personally ako, I would say that I really take it as a learning experience kapag

may case na “ay namatay siya because of this” and I try to use it as an improvement, so you want

to research more this type of disease kase gusto mong ma-treat siya eh diba, so para sa next time

makakita ka ng patient na ganun, alam mo na kung anong gagawin mo, what to watch out for, so

its more of you take this bad experience and use it for something better, use it for improvement.

R: So, despite the loss po, have you been able to find any benefits from your experiences of patient

death?

Participant: Yes, I guess yun nga, yung learning nya. Kasi eventually kailangan I-getover eh, so

hanap ka ng reason to make most out of something.

R: What do you think is the role of meaning making and self-compassion on being a doctor? Do

you think po ba na these two are important?

Participant: Hmm, yes. I think it’s important, pati empathy and compassion, tapos most of the time

rin patience, kasi tao rin sila, they want to be served, they don’t want to be seen as just a patient,

another case, or an object. They want to be… alam ng patient kapag the doctor is very

compassionate about them or they have the sense na they care for them. Ganon na rin sa sarili of

course dapat kung compassionate ka towards your patients dapat sa self mo din.

R: So overall, do you believe that these experiences changed you as a person?

Participant: Yeah, yes, definitely.

R: In what ways?

Participant: Ayun so firstly, it made me stronger, kase parang unang una kong makakakita ng

ganun, very emotional ko, but then after a while I had to learn how to cope with it, to not be so

attached, cause if you get to attached it can lead into depression. And then two, siguro it made me

strive to be a better doctor.

H3.

Participant 32 (45, Female, Pampanga)

Medical Practitioner (Pediatrics)

Years in profession: 11 to 15 years

No. of Patient Deaths: 1-5

HGRC Score: 1.33 (Low)

SCS-SF Score: 3.58

GMRI Score: 3.94

Participant: So ano bang gusto mong malaman sa thesis mo?

R: First if nageexist po ba yung grief sa medical professionals, kase yung nababasa po naming

articles, mostly grief lang po nung family. And kapag sa medical professionals naman po parang

may mga nagsasabi po na kapag for example yung doctor kapag affected sya masyado sa death ng

patient and pinakita po nila, ang unprofessional po, so parang taboo po yung topic na yun kapag

sa doctors and nurses. Like dapat po sanay sila and such.

Participant: Okay, ganito, meron kasing mga cases… kunyari ako may mga death na pag yung

patient ko premature, yung talagang inevitable yung death, parang yung level of grief ko hindi siya

as deep as yung… kunhari kase kunhari wala pa masyadong relationship yung parents dun sa anak

niya, so parang malungkot ka for them but after that kase madedettach kana eh, kase hindi mo siya

pwedeng dalhin all throughout otherwise mahihirapan ka magmove on, how will you face the next

patient ganon. Ako meron akong cases, especially yung mga hindi mo expect… nabibigla ka na

okay palang nun eh, tas bigla siyang nag seizure tapos after a few hours namatay, meron akong

ganon. Yun, medyo dinadala ko. I will explain. I have 2 sets of experiences, may experience kase

ako na, personal ah, eto kase nangyari talaga. Two cases of to consider Japanese B Encephalitis,

yung halos lahat ng deaths na naexperience ko ganon yung case. So meron yung mga iba na.. nakita

ko palang 2 days ago up and about sila, tas Nawala na yung fever, tas nagkafever ulit, then seizure,

and then wala na. So may mga times kase na nandun ako during that time. Na… samahan ko sila

ambulate ko sila dalhin ko sa tertiary hospital, the whole day nandun ako pero just to support the

family, pero alam ko na wala na yung bata, wala ng chance. Yun, ang sakit for me kase most of

the time only child, I have 2 patients, only child, kakaseven years old, kakatwelve years old, tapos

ganon yung nangyari.

So yun dala ko, parang in a sense na parang nalulungkot ako parang at that time naiisip ko yung

anak ko kase it could happen to my daughter. Alam mo yun? Yung… ang saket kase nagiisa lang,

but you could only do so much, parang ibinigay mo na, so parang ang saket…. Pero after that…

ganon talaga eh may mame-meet ka talaga na ganon na situation kase hindi naman tayo Diyos eh.

Ginawa mo lahat pero dun lang talaga. So yun may mga cases naman na sometimes… like yung

recent case ko, itong patient na to galling na siya sa ibang doctor, pabalik- balik siya, for a month

daw inuubo siya, so pagdating sakin edi nakita ko siya, kunwari tanghali…. Ngayon nakita kosya,

so nakita ko siya sa Sta. Ana tapos nagclinic ako ng Arayat, kaso super late na akong natapos,

siguro mga 9 o’clock na, so medyo pagod na ng konti. So, ang nangyari … so inaupdate ako ng

mga nurses, okay namn, walang problema, then the next day meron na akong previous family

gathering na kailangan ko talagang puntahan, dati na, kung baga naadmit lang to. So pinagbilin ko

siya dun sa resident on duty, okay lang siya the whole day, kaso nung night, naghigh-grade fever

siya. So pinabantay ko sa nurse, pinaano ko sa nurse, lahat-lahat na. So very stable daw, naglalaro

yung pasyente… okay, tapos sumasakit ang tiyan, so hindi na talaga ako makapunta kase madaling

araw na nung dumating kame. So, the next day humupa yung fever tapos tataas, humupa, pero

tutok yung nurse. So nung kinabukasan, humupa yung fever, tapos nagfever nanaman siya, tapos

nagconvulsion siya, pero nagpunta nako, so pagpunta ko nastabilize hanggang sa… pagpunta kong

ganyan… so lipat naten sa tertiary kase kailangan naten ng neurologist kase bigla siyang

nagseizure… first time. Inamin mismo ng mommy na nakikipaglaro pa siya, syempre may mga

ibang patient pa ako na ano… nirounds ko muna, after ko magrounds, naglunch muna. So biglang

tawag sila, so pagdating sa ER, “doctora stable siya” ganyan ganyan, okay, bumaba na yung feveer,

nag 37.5. Tapos kain muna ako, then when I was about to go, bigla daw nagseizure ulit, hanggang

sa bumagsak yung vital signs, so pagdating dun, umiiyak, galit yung mga lolo saken, parang

they’re blaming me, diko daw pinuntahan for 2 nights, when in fact pagdating doon, yung gamot

na binigay ko pinaakyat ko na sa brain, lahat na binigay ko. It just so happened na ang dating talaga

nung infection niya is encephalitis talaga, kase biglaan, bigla lang siyang nagddeteriorate, so tingin

ko yung kanyang part ng brain na nagggovern sa respiratory center niya tinamaan, nagseizure na

ng nagseizure, hanggang sa bumagsak na yung vital signs, syempre apektado. So ang masakit sakin

dun is parang, hindi ko kagustuhan, parang they’re blaming me for something na hindi korin

gusting mangyari, parang “eme pintalan ing anak ku”, when in fact pinuntahan ko siya nung

umaga, akala nila pinadala ko lang dun, tapos nung nandun na, dun lang ako nagpunta. Kase anak

alam mo ang doctor, hindi ibig sabihin na hindi kita napuntahan tonight, hindi na kita ginagamot,

kase everyday yung orders namen na binibigay tapos nakamonitor kami diyan. Kapag talaga super

emergency na, osige puntahan namen, kase minsan gaya nun, meron akong family affair na….

nalungkot ako kasi nangyari sa bata yun tapos ang cute ng bata, pero isa pa dun is, these people

are blaming me, well in fact I did everything I can, even if yung presence ko wala dun, pero nung

time na wala yung presence ko hindi siya toxic, you get my point? Pero nung andun na ako…

andun na ako eh, pero pano mo naman sasabihin yun sa relative? You cannot say it. Nung time na

nagagalit yung lolo, I didn’t say anything. So yung grief ko dun is, nalulungot ako kase… just like

yung other grieves na naexperience ko with ano.. kase inevitable… yun nga, yung explanation

parang sometimes hindi nila maaccept. Hindi narin ako nagexpound because I know they would

not understand.

R: Hmm kase sila rin mismo nag-grieve din p no?

Participant: Oo, tapos sarado yung isip nila. So, I do not blame them, pero sabi ko nga there are

people who know me, patients na alam ako kase sa totoo lang, just to explain, sasamahan ko pa

yun sa ambulance, private practice na ako ha? Hindi nako residente, kase pasyente ko na siya eh,

sasama ako sa loob ng ambulance. Pagdating doon, hindi ako magciclinic, babantayan ko siya. So,

at that time kaya hindi ako nakapunta ng gabi, because physically wala talaga ako. So sometimes

hindi talga maintindihan ng father. Yun umiyak ako, not because of the patient, but because

sometimes… minsan afraid din ako, baka these people would speak ill of me, and then they would

spread it to other people… hindi naman maalis yun eh, pero at the back of my mind sabi ko, if may

mga maniniwala, siguro those who do not know me, pero those who know naman how I take care

of my patients, I don’t think that they would think nag anon ako. Kase sabi ko nga minsan

masakit… sometimes you devote so much of your time for your job na to the point na kulang yung

oras ko para sa self ko. I mean kaya bilib ako sa mommy mo, she really took good care of you. I

mean she can choose her career, but she did not choose to, she took care of you. Pwede siyang

maghire nalang ng nanny to take care of you, and she can work, she has her choice, pero sinubmit

niya parin yung sarili niya sainyo. So ayun nga, sa ganung parte ng death sa patient na hindi pa

nila maintindihan na sometimes na for something that is inevitable na you don’t know. No doctor

would want his/her patient to die. So yung grief dun parang may kasamang ibang feeling parang

hindi mo naman gusto yun pero these people are parang blaming you. Buti nalang yung

neurologist… I did everything, lahat ng ginawa ko is ganyan, yung tama, yung dapat umpisa palang

eto na yung ginawa. Pero mero naming isang anti na nakasink-in sakanya. Kase siya yung… so, I

think nasa medical field siya kase naintindihan niya… Pero after that naman wala na akong

naexperience, tsaka ready naman ako to talk, pero wala naming nagreklamo. So yun yung part na

misan dala dala ko siya, ang lungkot ko. Ang lungkot ko kase parang you can only do so much

tapos ganyan pa yung nangyari. Parang, kung pwede nga lang anuhin, bakit hindi ko aanuhin, pero

wala ka nang magawa. Yun talagang… alam mo umiyak ako, tapos talagang ang lungkot lungkot

ko. Tapos hanggang sa the next day, may isa rin eh... yung isang to consider parang Japanese

Encephalitis, sila kasi yung biglaan eh, tapos meron akong isa ng patient, talagang nagpositive siya

sa blood test. So ang lungkot lungkot ko, pero yun yung pinakalatest, pero usually 1-day lang.

After that ippsych mo yung sarili mo. Hindi naman sa bato ka na, kase it come and then it goes eh.

Pero siguro dahil matagal nako in practice and galing pa ako sa government hospital, parang yung

ability namen to cope, yun yung term dun eh, with the grief. Mas ano na kami… kung baga yung

coping mechanism namin, mas nakakapagcope kame.

R: Yun po ba yung pinakadifficult niyo na experience? Yung recent lang po?

Participant: Oo, yun, yung pinakadinamdam ko.

R: Bukod po dun sa ang lungkot lungkot niyo po, meorn pa po bang ibang way na nag-grieve po

kayo, siguro po yung lagi niyo pong iniisip, hirap makatulog,

Participant: No naman, kase you know naman you did the right thing, so parang wala naman

akong… di bali sanang pinabayaan ko siya, maybe hindi ako makakatulog talaga. Yun nga lang

for every death na ano… ginawa ko kasi yung dapat, so yung parang nakukunsensya… it never…

hindi ako nobother.

R: May parang specific thing po ba kayo na ginagawa everytime na, kunhari talking to you family.

Participant: Yes, oo, when that time happened, I opened it up colleague, dun sa neurologist, dun

sa bestfriend ko na doctor din, tapos sa husband ko. Pero sometimes, pag ganyan kase you talk

more with your colleagues, kse itatanong mo yung, “what could have been done?”, “may mali ba

ako?”, pag ganon kase sasabihin nila kung ano yung objective, tapos hanggang sa they would share

their previous experiences, so nakakagaan yun. Pag tatanong mo “Did I do something wrong?”,

tapos they would objectively say na… pero sa akin naman wala pa akong nakita na “No doctora,

you should have done this”, no kase nga you did everything eh, kasi eku neman akuan ing eku

agyu eh. If I have to refer, I refer, parang ganon, kase general pediatrics lang ako eh, so pag

kailangan ko ng neuro… ano, kailangan ko ng neuro, kung kailangan ko ng pulmo, so ano siya

talaga, group practice.

R: May iba pa po bang ginagawa?

Participant: Oh, I pray, nagp-pray ako syempre tapos tapos nabibigyan ako ng tibay ng loob gaya

non… it happened in Mt. Carmel, after that I went to church near Mt. Carmel. After the incident,

and then after that I called the neuro, tapos I called my husband, tapos yung bestfriend ko.

R: Aside from the factors that you mentioned, na yung biglaan, and yung sa family po. May iba pa

po bang factor na you think made this death a bit more difficult?

Participant: Yun nga, the misconception of the relatives at that time na, they thought I took them

for granted.

R: What about yung age naman po nung patient?

Participant: The older the patient, the harder it is. Gaya nga ng sabi ko sayo, if it’s a premature

baby, wala pa kasing deep relationship yan eh, pero pag 1 year old, 2 years old, 14 years old, 7

years old… masakit yan. And matagal mo siyang kasama, it hurts me at that point, kaya parati

kong sinasabi sayo pag ganon, parang ang saket kase it could have been my child. Alam mo yun?

Yung ang saket kase magulang ka eh, alam mo yun? Pag inisip mo ang sakit sakit. There’s a

particular phase during that day, there is a particular moment during that day, after the death, yung

grief mo nandun, but then after a while you move on. Para kang kwerdas na after that okay na…

wala eh, kasi we were trained to be like that eh. We cannot show emotions in front of the relatives.

We have to be strong, we have to be like… hindi naman poker face, pero hindi ka pwedeng iiyak

sa haraap nila, edi magiiyakan na. You cannot do that, but minsan kapag habang rineresuscitate

ko, naiiyak ako, wala akong choice naiyak na ako eh. Pero most of the time I am not like that.

R: Kung ira-rate niyo po from 1-10 yung grief na nafeel niyo over that patient, how much would

you rate it?

Participant: Sa lahat naman 10 yan eh, I mean the patient died.

R: Yung difference lang po niyo siguro sa ibang doctors is after 1 day, kase po sa mga iba naming

nainterview may mga nagtagal din yung feeling, usually po sa mga new doctors.

Participant: Oo, maiisip mo sila pero hindi na as hurting during yung time na yun. But you think

about it, sometimes you go back, sometimes naiisip mo sila. All of them, sometimes naiiisip mo

sila. And then after that ano, kase you have to move on, hindi ibig sabihin na insensitive ka, yung

nga lang napansin mo sa mga older ones medyo ganito yung sakin? Pero yung mga bagong

graduate kase syempre first death nila yun, talagang ano sakanila yun, dipa gaun katibay yung ano

nila.

R: So, in what way if any did this loss of a patient affect you emotionally?

Participant: With emotionally… at that time… you mean like after that hindi na ako

masyadong,yung parang everyday routine affected parang ganon?

R: Siguro pwedeng in general napo, after all experiences of patient deaths, yung mga experiences

po nayun pano po yung effect nila sa emotional aspect niyo po? Mas naging tough po ba kayo?

Participant: Yes, oo, emotionally, yun nga, everytime na nakakaexperience, yun nga mas nagiging

tough… kase nga yung coping mechanism ko is…. Mas magaling na akong magcope sa mga

ganong klaseng experiences. Although, one experience is different from the other, yun nga lang

mas less… mas kaya mo, mas kaya mona hindi maapektuhan yung mga kailangan mong gawin.

Kase hindi pedeng just because of that sira na buong araw mo. Hinde pede kase mamasyente kapa,

magrounds kapa, nanay kapa. Alam mo yun? Hinde kase pwede na ganun otherwise hindi nako

magiging effective sa araw nay un. So, mas naging tough ako.

R: How about professionally naman po? May nagbago po ba on how you treat your patients?

Participant: Yes, of course, kase everytime may mga ganung cases kami, kase every case ay iba.

Kahit pareho kayong nagdengue, iba yung dengue ni Juan, iba yung dengue ni Pedro. For every

death na ganon, kung careful kana, ams nagiging careful kapa o kung ano pa yung kulang doon,

mas natututo kapa so para sa next time, para sa next time… para eto paying gawin ko, hindi ganito,

or iiwasan ko ito para hindi ganito. For every time na ganon, kung baga it’s a learning experience,

para may gawn kame, para sa susunod kung may pagkukulang man, hindi na mangyayari

R: What about your level of attachment niyo with you patients?

Participant: It didn’t change, yung level of attachments ko sa patients ko hinde, pareho lang.

R: Tingin niyo po bakit hindi?

Participant: Yun nga, because…

R: Ever since naman po same lang?

Participant: Oo, same lang, like for example, because of that death kailangan for very patient ko….

R: bawasan yung ganon poba?

Participant: What do you mean? Yung dapat hindi ako magiging ganun kaattached?

R: Opo.

Participant: Hinde, kase same lang, walang pagbabago. Kunyare after that kung pano ko tignan

yung each and every patient, pareho lang kung paano yung dati. Kung ano yung dati ko, siya parin

ako. Sigur lang, mas more careful, mas dadagdagan mo pa ako.

R: What about your confidence naman as a doctor?

Participant: Hindi siya nagbago, mas natuto ka nga eh. Although, minsan yung parang there was a

time na sobrang sadness mo minsan parang “ano ba to?” parang ganyan, misana parang “ayoko na

ata”, yung ganon, minsan gaganon ka, totoo. Pag yung shock factor? May ganon. Pero at that point

lang, yun lang kase parang iisipin mo rin na marami karing natulungan, tinutulungan, at gusto pang

tulungan. So yun yung, gaya nga nung sinabi ng isang doctor… yun yung resident doctor na

tumingin dun sa time na yun, Tas sab inga niya “Doctora, wag mong isipin yan, isa lang yan,

tandaan mo mas marami tayong natulungan, tinutulungan, at maraming pang tutulungan.” Sabi

niyang ganon. Pero syempre tao ka lang, nung oras na yun, yun yung pakiramdam mo eh, minsan

hinihintay mo rin na sabihin sayo yun although alam mo naman yun sa sarili mo. Pero after that

okay kana.

R: Next po is, isa po dun sa mga scale is on self-compassion. Yung being compassionate to oneself

po during difficult times, on times of failure? For example, during that time na namatayan po kayo

ng patient. Yung self- compassion po kase is yung, parang pag assure niyo po sa sarili niyo na

katulad po ng sinabi niyo na “You can only do so much.” What do you think is the role of self-

compassion naman po in being a doctor?

Participant: Kailangan na kailangan ng isang doctor yun, kase kung hindi ganun yung attitude

niyam hindi na siya maging effective. Kase one doctor couldn’t blame himself/herself, like yung

“kasalanan ko to, kasalanan ko to”. Yun ba yung ibig mong sabihin?

R: Opo kase po diba as a doctor, dapat po compassionate kayo towards your patients-

Participant: Tama and not just that you have to be compassionate towards yourself also, wag mong

incriminate yung sarili mo, walang doctor na ganun. Kase nga hindi ka na magiging effective after

that, unless otherwise talagang you know sa sarili ma na nagkulang ka. Pero gaya nga nung sabi

ko, walang doctor na ganun. So ayun after nun dapat psych it up, isipin mo okay na to, para after

that incident, effective ka na ulit. Kase ka lang doctor eh, nanay ka rin, kapatid ka rin, kaibigan ka

rin, alam mo yon? So, pag ginanon mo dahil lang sa puntong yun, Ay naku! Sira kana, kaya

kailangan matibay ka.

R: So how do you balance your emotions and responsibilities po?

Participant: By being aware na eto hanggang dito lang, you have to psych yourself up na after this

ang ginagawa ko, yung nga umiiyak ako, talk to my friends, talk to my loved ones, then after that

assure myself na okay na. And then after that eto na. So ganun lang ang gagawin mo, you have to

bask it all out, pent up emotions and then after that you learn from that experience and then after

that, you move on. Ganun lang ginagawa ko para mabalance.

R: How much sense would you say you have made from the lost. Parang yung meaning po nun sa

sarli niyo, paano niyo po minake sense yung nangyari. And yung meaning making po kase is yung

parang yung sense finding and benefit finding. Tas despite the loss, have you been able to find any

benefits from your experience?

Participant: Yes, because of that, Eto ah, de nakakatawa lang kase… parang… not because of the

death ah? Kase pano ko ba sasabihin ito. It’s not because of the death, diba gaya nga ng sabi ko,

we did everything eh, so yung question ko is about the death, kase diba sabi ko nga sayo yung

ibang nag transpire dun sa event na yun. So, if you’re talking about the death, anong sense ang

nakuha ko don? Something like that?

Kase parang kung baga ano yung meaning nung experience na yun saaken. Yung experience na

yun, yung loss of a patient, yung ang nagaano saamen, na talagang we cannot be God. Yun nga

gaya ng sinabi ko “You can only do so much.” Yun nga lang, siguro if you could turn back yung

clock, siguro mas magkakatime pa ako dun sa patient na yon. Pero ang meaning nun is for every

death kase, if you give everything, dun lang naten makikita yung… ang pagiging doctor… kung

baga, these people are “Oh ang taas ng ano…”, pero hindi tayo Diyos. Kahit na anong gawin mo,

kung talagang…… yun na yun, it all goes down to… yun nga, you can only do so much. Yun lang

sa akin, parang yun yung meaning, yung sometimes kailangan pumasok sa doctor yung humility

to accept yung limitations niya na eto lang yun, despite doing everything, kase wala, talagang yun

lang yung gagawin mo. You cannot question science, you cannot question God about it. Siguro

yun lang.

R: If icocompare niyo po yung present self niyo during that time na first niyo pong naexperience

ung patient death, paano niyo po id-differentiate?

Participant: Mas mahina yung loob ko nun, gaya nga ng sinabi mo yung mga bagong doctors, yung

residency, parang mas mahina, mas apektado ka. Yun nung yung residency ah? Pero as private

practitioner, yung unang death, kase patient ko na yon, masakit din syempre. So kumpara mo noon

sa ngayon, mas nagimprove yung coping mechanism ko, yung self-compassion ko, mas

mapagpatawad ako sa sarili ko kesa nung una, kase ano ba yung ginawa ko, ano ba yung kulang

ko. Syempre bago ka palang, pero as you go on, syempre yung confidence mo, yung learnings mo

mataas,tumataas, so mas ano ako ngayon, mas kaya ko ngayon kesa nung una

R: So, can you tell me how you see yourself as a doctor?

Participant: I’m a type of doctor na… I always put myself, dun sa situation nung patient ko, at the

same time, I’m the type of doctor na…. when people come to me sa clinic, basta iisa lang yan,

yung alang makwalta, alang ali, basta metung kamu. Siguru uling nagtraining ako sa isang

government hospital. Na ang exposure ko mas marami sa masa, so laahat yan iisa lang yan, so yun,

so yun yung perception ko sa sarili ko, so parang very sympathetic, empathetic sa patients ko,

minsan kahit natutulog pa ako, tapos iisipin ko, kamusta na sila yung ganon, especially yung mga

nakaadmit. Basically, yun ako, very humble ako kase if you’re not sincere in what you do, hindi

ka mab-bless, you get my point? Parati nga nilang sinasabi, if you want to get rich, I’m sorry but

you’re in the wrong profession. Because being a doctor is not a guarantee to be rich, maraming

doctor ang hindi nagsa-succeed. Pero hindi ka magugutom, definitely, pero hindi guarantee na

yayaman ka talaga. So, if you put that sa utak mo, ao kase hindi yon, kung ano man siguro yung

blessings, maybe because…. Gusto ko lang kase talagang manggamot eh, gusto ko yung ginagawa

ko. So yun yung perception ko sa sarili ko as a doctor, yun nga lang, sa sobrang naging busy ako,

sa sobrang mas naprioritize ko yugn family ko, nagsuffer yung time ko sa ano ko. Kase parang ang

hirap, kase minsan, syemre nagc-clinic, anong oras na ako natapos. Pero during that time kase,

when I was starting my private practice, I had to work, I had to practice, kase may sakit yung

parents ko, and at the same time were starting, ganon. So medyo nagsuffer ng konti, hindi ko

masyadong natutukan yung daughter ko, e magisa lang siya. You can’t have it all.

R: Ano naman po yung best and most difficult aspects of being a doctor for you?

Participant: The best aspects for me is, Number 1, nabless ka ni God sa pag-aaral mo para

manggamot. Alam mo yun? Yung the joy pagpunta ng pasyente mo umuubo, sumisipon, after 3

days, pagabalik niya hindi na. Alam mo yun? Yun yung the joy of being able to help this people

abbreviate kung ano man yung pain, ng anak nila, not necessary the child, sa pedia kase kasama

parents eh, so alam mo yun? Pag nakita mong “Doc, ene pu lalagnat”, nakang katula, yun yung

unang una. Tapos ano pangalawa, dahil sa paggagamot mo, dahil nga yan, kung what am I right

now, kung ano man yung blessings ko, yun, yung isa sa mga naging joy of being one. Tapos, let’s

be honest, sa philippine society kase, yung mga postgraduate courses like abogacia diba?

Medisina, yung society parang, yung respect nila dun sa mga ganon, diba? Kaya dapat minsan

conscious ka sa mga actions mo, pero minsan tao kalang, kapag may kasalanan yung katulong mo

minsan nagagalit ka diba? Kase tao kalang, dika naman magagalit kung wala siyang ginawang

kasalanan, sumisigaw ka, tao kalang eh. Pero sometimes when you go outside medyo conscious

ka kase these people look up to you. Tapos isa pa yung gusto ko dyan, yung parang, now that they

see me like this, naiinspire ko yung ibang tao. Kunwari yung pamangkin ko, naiinspire siya saken.

Pero parati kong sinasabi sakanila, “Magmemedisina ka dahil gusto mo ah? Pero hindi dahil

nakikita mo si tita nageenjoy”, totoo na may ganun ha. Kase pag yun ang inuna mo, wala ka. Yun,

yung nakakainspire ka, kase kung gusto ko lang talaga yumaman, kase pag nagtetraining ka, edi

kung gusto ko bat hindi ako nag OB? Diba? Bat hindi ako nag-ganito? “kase mas maraming pera

dun.”, pero kase pag nandun nay un, hindi mo iniisip, ang iniisip mo kung ano yung hilig mo. Most

difficult naman, eh nakwento ko na kanina yun nga yung some people don’t see everything yet

they are so quick to assume na hinayaan mol ang yung patient kapag something unfortunate

happens. And lalo na of course yung time, time talaga, minsan sa sobrang busy wala na akong time

for my family, lalo na sa anak ko, sometimes hindi ko rin natitignan lahat ng patients kasi as a

person may limits ka rin. Ayun. Wala naman na ata.

H4.

Participant 47 (30, Female, Metro Manila)

Medical Practitioner (General Practice)

Years in profession: 1 year

No. of Patient Deaths: 6-10

HGRC Score: 1.76 (Ave)

SCS-SF Score: 2.58

GMRI Score: 3.22

R: Before we start, can you tell me a little bit about yourself po before we jump into the specific

research questions?

Participant: I am Dr. Ferrer, I had my internship in DOH tapos just passed the board exam last

September 2018, so now I am practicing as a general doctor in Cavite. I am not affiliated to any

hospitals right now but I had my fair share of hospitals during my internships and clerkships in

med school.

R: Ohh to start po, how do you see yourself as a doctor?

Participant: Before, I planned to apply sa doctor to the barrios kaso lang for some reason I cannot.

So since nung internship, I felt na I’m leaning towards pathology. Kaya yun yung naging gusto

kong field, siguro pag nagkachance na magspecialize kukunin ko na. Naisip ko kasi na pathology

handles laboratory, why not take advantage of it and make a portable na like clinic or lab to take

blood samples and electrolytes so that yung doctors natin sa far flung areas yun yung magamit. In

that aspect of life naging doctor to the barrio ako but ibang aspect, gawa mo tapos ibigay sa iba.

Kasi hindi ko talaga kaya.

R: What can you say are some of the best aspects of being a doctor?

Participant: Best aspects of being a doctor, helping others who are in need of medical assistance,

it is actually a privilege na makatulong sa iba na magprovide ng medical assistance in any way.

R: What can you say naman po is the most difficult?

Participant: difficult aspect of being a doctor? Difficult part of being a doctor yung nakita mo yung

patient mo na kayang mo gawin lahat to save that patient however financial constraints. Yung

hindi mo mabigay lahat ng kaya so you’re left with nothing. Yung healthcare kasi dito sa atin,

somewhat accessible but not free so yun yung difficult part, yung kaya mo gawin lahat pero you’re

hindered by money problems. So yun.

R: About your experience/s of patient death naman, on average how many deaths of patients do

you deal with on a weekly basis or if not weekly, monthly?

Participant: Nung internship and clerkship, siguro monthly at least once meron ako na encounter.

Pero yung ako talaga, na nakakita, nung ako talaga nag attend, around eight. Pero if assisted,

syempre may ibang doctor or intern, monthly basis talaga ako nakaka experience.

R: Ohh now naman po I want you to think of one particular patient who died that was particularly

difficult for you. Can you describe the patient for me?

Participant: It was my patient nung operated for, not sure if kidney stones but somewhere sa urinary

tract. So this patient was being hydrated tapos hindi namin nakita kagad na marami na pala siyang

complications. So yung patient na dehydrate and nag go into shock tapos namatay under our care.

What particularly struck me most was that this patient was nandoon kasi yung anak niya while we

were doing yung resuscitation. So after a while di na talaga nag respond yung patient, lumapit

yung anak, sabi ng anak was “okay na, sumama ka na kay mama. Wag mo na kami problemahin.”

we were holding back our tears.

R: Matanda na po ba noon yung patient?

Participant: Parang around seventies. It was like two years ago na.

R: Yung relationship niyo po with that patient would you say it was long enough to build a

relationship, like doctor-patient?

Participant: Hindi siya long enough kasi we were just monitoring the vital signs and checking on

him from time to time. To check if kumain, hindi kami yung parang over him. Ganun lang naman

yung relationship namin.

R: What would you say yung nafeel niyo nung experience na yun besides yung holding back the

tears?

Participant: Syempre, yung guilt sa part namin kasi parang…in our case kasi parang it wasn’t our

fault kasi we were just monitoring the patient

R: So, like was it sudden and unexpected po ba?

Participant: Oo? kasi hindi naman siya yung expected na mangyayari na parang ganito ganyan. At

tsaka kasi pwede naman ma-prevent yung cause nung sudden shock nung patient. Para samin may

pagkukulang ba kami, yun yung feeling namin.

R: What about after the experience? What did you feel?

Participant: After the experience, siguro we were more maingat na in monitoring patients. May

off lang ng konti we’ll refer to our senior kagad namin. Unlike before na parang okay pa, on our

own discernment. Ngayon na parang pag off na, parang di namin alam if mag under refer or mag

over refer kami kasi mapapagalitn kami pag OA. Basta you did your part. Parang wala, wala

walang masasabi sayo.

R: So ano po yung ginawa niyo after the experience? How did you cope with what had happened?

Participant: In the medical field kasi di mo talaga maiiwasan na magkaroon ng mortality. So sa

ganun parang di naman dapat wala yung emotions pero yung empathy sympathy you cannot show

it to the relatives. You have to explain it to the relatives; you have to be professional. Hindi pwede

yung umiiyak magsasabi ng sorry po. You have to act professionally. You have to bottle up your

emotions muna. Explain muna sa relatives tapos dun mo ilabas pagkatapos. You have to have an

outlet afterwards, from your colleagues, your relatives, your mother or father ganun. Kasi if you

don’t open up parang maaapektuhan din yung work mo.

R: So, would you say na yung factor that made this death difficult was yung time po na kinausap

ng anak yung patient mismo?

Participant: Ako kasi I’ve seen a lot of deaths, sa iba mapapadaan lang ako. Pero sa case na to kasi

as in yung anak hindi umiyak, parang composed. Inisip muna niya yung tatay. Lalaki yung anak,

so yun inisip muna niya yung tatay. Emotions niya parang bottled up. Sakanya okay na, so sobrang

silent namin. Sobrang hiwalay siya sa lahat ng nakita ko. Di siya humahagulgol, umiiyak pero

composed na composed siya, kahit sudden na nangyari.

R: Would you say na meron kayong na feel na grief over the death of that patient?

Participant: Oo syempre, in any death naman of a patient.

R: Ano po yung nafeel niyo nun, like what did the grief look like, did you think about him often,

did you have trouble sleeping?

Participant: Hindi mo na siya matatanggal sa isip mo kasi lesson learned na yun. Parang yun nga

with what I told you a while ago, we were more maingat na sa mga patient namin kasi ayaw na

namin mangyari yung nangyari noon. Naging OA na kami mag refer.

R: Naiyak po ba kayo after?

Participant: Oo nung umalis kami sa room, tapos nagusap-usap kami. Pero death is death, and there

are a lot of patients pa. So yun siguro dahil it’s sudden, and that was the first talaga na hindi namin

na expect kaya affected talaga.

R: Mga gaano po katagal yung grief na nafeel niyo po nun?

Participant: Hindi naman nagtagal talaga, siguro mga one day lang. Kasi nung sinabi samin sa

orientation, you have to move forward kasi we have other lives to save. We can’t save everyone.

Yun yun eh, we cannot save everyone, but we can save who we can. Parang kami sige one day,

iinternalize namin kasi kailangan kami ng ibang tao. Pero of course every now and then, may times

rin na you’ll remember pero okay lang.

R: Kung tatanungin po kayo kung pano kayo naapektuhan emotionally nung death ng patient na

yun. What way did this loss of a patient affect you?

Participant: Parang it made more emotionally prepared to handle to such things. Parang dati kasi

di mo alam pano ittake in yung death in front of you and yung reactions ng relatives but now

parang with how I deal with it emotionally, mas prepared na ako. I have to kasi, paano kapag mag-

isa lang ako in a situation like that? Meron akong friends who did not handle it, afterwards umiiyak

sila sa residents nila. Nung after nung incident na yun, parang more composed ako. More

emotionally prepared kasi kahit after nung death kakausapin ka pa ng relatives.

R: What about professionally naman po? Naaapektuhan po ba yung motivation niyo to go to work,

yung the way you treat other patients, your confidence as a doctor?

Participant: With other patients siguro, mas naging maingat kami. Hindi naman sa sinasabi ko na

hindi kami maingat dati pero kasi dati naooverlook. Yung kami ngayon parang pag may off lang

na konti sabihin kaagad sa residents. Kasi parang dati text lang, now nagkaroon ng mas magandang

communication within the medical team.

R: What about your level of attachment with your patients,naisip niyo minsan na di dapat maging

super attached sa patient kasi what if something happens and it would affect you.

Participant: Oo parang ganun din, as a doctor dapat meron kang sympathy sa patient but you have

to detach yourself, so you don’t get too emotionally attached to your patient kasi ikaw yung doctor

nila. You have to think as a doctor not as a relative.

R: What about your confidence naman po as a doctor? Naapektuhan po ba because of the incident?

Participant: Once again oo, kasi parang chineck if may lapses kami. Pero afterwards, your

confidence as a doctor mas ipprevent mo na yung ganun na pangyayari

R: Bukod po dun meron po ibang effect yung death ng patient nayun sainyo po?

Participant: Siguro yung effect talaga niya sakin is I became tougher? Kasi in front of the relatives

di ka pwede maging emotional. You have to be tough kasi as a doctor you have to be firm. Doctor

ako eh, alam ko yung nangyari sa patient so kailangan ko iexplain sa relatives kung ano nangyari.

So syempre you have tough but at the same time you have to me empathetic.

R: Pang ilang patient death niyo na po pala yun?

Participant: That was my third one.

R: What do you think are the other factors that make a death difficult bukod pa po dun sa andun

yung family? Bukod sa reasons na andun yujng family ganun po. Magmamatter po ba yung age,

yung sakit? Ano po yung factors na nagpapahirap sa isang death for you?

Participant: Aside from the factor of the relatives, death as a whole ah? Siguro yung factor of

helplessness kasi as a doctor yung step by step yung gagawin. Pero once na hindi siya

nagrerespond, yun yung pinaka mahirap kasi binigay mo na lahat ng alam mo pero wala parin

nangyari. As a doctor nakakasad, nakaka depress.

R: Naaalala niyo po ba yung scale about self-compassion? Yung sa isang scale na sinagutan niyo

sa survey namin. Yung about being kind to oneself po. Tapos yung score niyo po dun is categorized

as high. What do you think is the reason po why high yung self-compassion niyo? Do you think it

has something to do with how you balance your responsibilities as a doctor? Like especially when

handling patient death.

Participant: Well kasi as a doctor, you can only do so much. Hindi ka diyos, hindi mo kayang

buhayin yung patay. Parang you have to forgive yourself kasi you did your best. Kasi meron

talagang time na gawin mo lahat, you won’t be able to get a patient’s life back. So parang patawarin

mo sarili mo kasi ginawa mo naman lahat.

R: So like mayroon or like malaki rin po ba yung role po ng self-compassion to being a doctor?

Lalo na po sa death?

Participant: Oo, kasi mabuburnout ka with the other fields na like internal medicine na they deal

with death day by day. So if you don’t forgive yourself, meron nga na sinabi ng senior ko before,

may kwento siya, there’s this lowerclass who asked him before, doc I experienced a death today,

was it my fault? Tapos ang sabi ng senior, it was not your fault. You can only do so much.

R: May particular things po ba na ginagawa to balance your emotions and responsibilities as a

doctor?

Participant: Siguro more of iniisip ko yung welfare ng patient rather than my emotions. Pag doctor

ka kasi dapat di mo ibigay yung empathy. Empathy siguro konti. So ang ginagawa ko is I try as

much na wag masyado maging attached sa patient. I try to do my responsibilities as a doctor.

Kungwari di talaga maiiwasan, kasi meron talagang interaction, maaattach ka talaga sa patient.

Tapos what if may mangyari pero wag naman sana. Pero ayun nga meron ka na connection with

the patient. Ako I try to be more on the professional side.

R: So regarding meaning making naman po. Yung sense making of the loss. How much sense

would you made of the loss. If you were to rate it from a scale of one to five, with one having not

being able to make sense of the loss tas yung five po made a great deal from the loss.

Participant: How did I make sense of the loss? One is the lowest while five being the highest?

Tama ba ako? Okay. Mga four siguro kasi day by day parang I might encounter another case na

ganito.

R: So, like you learned from your experiences na po?

Participant: Yes.

R: Next naman po. Despite the loss, have you been able to find any benefit from the experience?

May nakuha po ba kayo na benefit from the death ng patient? Bukod sa naging emotionally tough

po kaya ganun.

Participant: Siguro being more compassionate in everything we do, kasi it’s just not us being

monitoring. We are part of the team. So, you have to be more compassionate with the patient.

R: So what do you think is the role of meaning making on handling patients. Yung meaning making

po yung process. What do you is the role of meaning making on handling patients’ death? Yun

yung finding meaning from loss and negotiating with your mind na meron benefit sa loss na ito.

Participant: Like a silver lining? You mean?

R: Opo na parang meron reason for everything. What do you think is the role of it po on handling

patient death?

Participant: Kapag ganun it makes you more professional. Work ethics mo kasi. Mas nagiging

professional ka kasi iiwas ka sa burnout. Yun yung kalaban ng doctors when they’re dealing with

death day by day or more often than other doctors. Nakakaiwas ka sa guilt na everyday may

namamatay on your care pero hindi mo talaga fault kasi.

R: So overall, do you believe na nag change kayo as a person ever since that experience of patient

death?

Participant: Oo.

R: How much do you think po from siguro one to five, five being the highest.

Participant: Siguro around mga 3.5 lang, other factors parin kasi, its just one death. In every death

parang oh ganito pala, may narerealize ka sa self mo na paisa isa. Yun yung biggest impact siya

na as a whole siya. Diba nga eight deaths over my watch, so yung other seven parang meron ako

onti onting nakukuha na narereveal about myself.

H5.

Participant 1 (24, Female, Metro Manila)

Clinical Clerk (Junior Intern)

Years in profession: 7 months

No. of Patient Deaths: 11-20

HGRC Score: 2.96 (High)

SCS-SF Score: 2.67

GMRI Score: 2.28

R: How would you describe a typical day of work or like duty as a clerk?

Participant: So typical day, uhm it would depend sa kung anong post mo, kung anong department

ka naka-assign, so may mga preduties, then duty status, tapos post-duty status. So usually kapag

nasa wards, in general each student may naka-assign na patient, ikaw non yung SIC (student-in-

charge). Ikaw bahala nun sa patient na yun, yung sa history, you check on them every day, note

and review yung chart, tapos you carry out if ever may orders yung residents ganon.

R: How do you see yourself as a future doctor?

Participant: Medyo di ako sure haha. Kahit ilang months na kami into this we’re still getting the

hang of things. Kapag clerkship kasi more on in-hospital, so like yung in-patients. But then another

big aspect of doctor life is yung check-up sa clinics, so yun ngayong clerkship wala pa kami

masyado experience sa outpatient minsan lang kapag nagrrotate kami sa OPD. And kapag ganon

ang dali kong mapagod actually kasi daming patients tas yun napapaisip ako na ganito ba talaga

ginagawa ng doctors, yun di ko pa alam.

R: What do you think are some of the best aspects of being a medical professional?

Participant: Favorite aspect ko is being able to get to know the patients, like kasi sa PGH, Malaki

yung volume ng patients and yung variety ng mga sakit nila, marami talaga. But more than that,

very interesting malaman yung history nila, yung bakit sila nagkaganon, yung context, like for

example siguro yung part ng culture, socioeconomic status, and lalo na yung personality nila that’s

the part I look forward to getting to know the most.

R: What do you think are some of the most difficult aspects naman po of being a medical

professional?

Participant: Uhm yung namamatayan.. haha. Uhm, the most difficult aspect besides yon the

obvious na you can’t save everyone. I think it’s the health system we have here sa Philippines,

sobrang wala, we deserve more, the patients deserve more.

R: On average how many deaths of patients do you deal with on a weekly basis? If not weekly,

monthly

Participant: It depends kung saan ka nagrrotate, for example, may rotations na super stable ng

patients like sa ortho di naman sila mamamatay. But noong nag internal medicine kami, every day

may mortality. Eh 1 month kami noon sa IM, kaya yung answer ko sa survey kung ilan patient

deaths na is 11-20.

R: Now, I want you to think now of one patient who died that was particularly difficult for you.

Can you describe the patient to me?

Participant: Uhm, I think most difficult yung first patient ko na ako yung student-in-charge, so

ayun nagmort siya unexpectedly, like biglaan lang. She was a 70-year-old na lola, she was admitted

because of a mast, may bukol siya sa lungs niya and we were considering malignancy.

R: When did this happen?

Participant: It happened nung January, mga second week ata naming in IM.

R: How long was your relationship with the patient?

Participant: I think it was less than a week lang.

R: Could you tell me more about what happened? Like what did you feel during the experience?

Participant: Uhm sobrang biglaan talaga. Kasi diba sabi ko kapag SIC ka, every day you check on

your patient, every day you note sa chart kung kamusta na sila. But on that day, I think I was busy

doing something else first tapos kumatok yung resident in charge dun sa patient na yun sa call

room na yun nga, nagiging hypotensive yung patient, nagiging unstable yung patient so icheck ko

daw in a few minutes. But on that same day, it so happens to be the same day that I had to present

a report which was a higher priority supposedly. So ayun, nakakainis kasi na I was still working

on my presentation tapos need ko icheck yung patient, but at the same time tinatawag na ako ng

blockmates ko kailangan ko na pumunta sa report pero nasstress din ako sa patient ko. Siya rin

kasi yung patient ko na naging pinaka-kaclose and sa kanya talaga ako pinakamalapit na patient

kasi she was very sweet, and no one expected it to happen. So yun naiiyak na ako, but I had to call

the interns to cover for me para maalagaan siya, and then I had to go na. Tapos while I was on my

way to the classroom, nagmamadali ako naiiyak na ako, doon sila nagcall ng code. Yung code kasi

is when kapag magreresuscitate na so icchest compressions ganon. Naiimagine mo ba? Diba? So

yun, sobrang frustrating ng time na yon kasi naririnig ko sila pero I had to go somewhere else kahit

na I have to be there rin for my patient. And ayon, so habang nagrereport ako wala, ginisa pa ako

ng consultant haha. Wala, sobrang nakakafrustrate and I had to keep it inside kasi syempre

nagrereport ako. Tapos in the middle of the report, tinext ako ng intern sabi, “Girl, nagmort yung

patient mo.”. So yon parang ako, inside I was like “oh my god”. And then yun, natapos na report

ko, nakabalik na ako sa call room di ko inexpect pero ayun pagbalik ko as in umiyak talaga ako

nang sobra sobra and then humagulgol talaga ako. And then isa pa sa pinakaayaw kong parts that

day is of course since namatay yung patient kailangan mo asikasuhin yung after-death stuff like

death certificate, etc. Then wala, resume ka na sa day mo like normal.

R: What did you feel after the experience?

Participant: I felt guilt talaga non, kahit nirereassure ako ng blockmates ko nun na okay lang yan,

na there are some deaths na unexpected talaga. Like for her, pulmonary embolism na sudden talaga

eh. Pero kahit ganon di ko matanggal yung sense of guilt, kasi feeling ko talaga I could’ve done

more. Also, feel ko kailangan ko talaga ng debriefing noong time na yon, pero I don’t know, wala

eh parang hinahayaan lang kami. Like okay, nangyari tong big thing na to, someone just lost a life,

someone’s family just lost a loved one, pero you just have to go on with your day kasi mayroon

ka pang other duties to do.

R: How did you cope with what had happened?

R: What about your seniors po? Were you able to talk to them?

Participant: Wala haha. Wala akong nakausap.

R: What factor do you think made this death more difficult than the others? Like what’s the biggest

factor that made this particular death difficult?

Participant: Yung biggest factor na for me is yung pagiging pinakamalapit na patient sa akin niya.

Sobrang bait kasi niya, sobrang sweet sa akin, medyo kabado siyang tao kaya narereassure ko siya.

Ayun okay talaga yung rapport namin.

R: So, would you say that you felt grief over the loss of this patient? If so, what did the grief look

like and how long did it last?

Participant: Uhm paano ba? What is grief? Hahaha. Kasi for me kung physically, yun umiyak

talaga ako. But like if naka-affect siya sa living ko I’d say na siguro isang day lang but I would

still think about it sometimes parang ganon.

R: In what way if any, did this loss of a patient affect you personally?

Participant: I think it depends for every person but for me ayun narealize ko na I don’t like losing

patients to death. Parang napaisip ako na, ayoko ng specialty na may namamatayan. Also, feeling

ko I could’ve done more. But yun minsan ang dami lang talaga ginagawa, pero it made me want

to be a better doctor.

R: Professionally? Like naapektuhan po ba yung level of attachment niyo with your patients, how

you treat them, etc.?

Participant: Never ako naging attached to any other patient like I was to her, feeling ko dahil sa

kanya talaga like how she treats me, parang close talaga kami. Syempre I try din sa other patients

nag anon pero iba talaga eh.

R: What about yung confidence niyo naman po as a future doctor?

Participant: To start with, like I’m not the best naman sa batch naming like actually, below average

pa nga ako. So, baseline, mababa na actually yung confidence ko so I don’t know paano siya

naapektuhan but I guess bumaba pa lalo ng konti dahil doon.

R: Next naman po is self-compassion. What do you think is the role of self-compassion sa grief

reactions na naeexperience niyo po?

Participant: Well I think it helps me know how or like when to self-reflect. Mahilig akong mag

self-reflect. One thing I learned in med school is that it’s important to choose myself. I like taking

care of my mental health, so I take time to reflect ganon. I take time for myself kase kung hindi

I’m gonna hate my life haha parang ganon naiisip ko.

R: Moving on po, how much sense would you say you have made of the loss? Rate using 5-point

Likert-type scale, 1 (I have been able to make no sense of my loss) to 5 (I have made a great deal

of sense of my loss).

Participant: Siguro mga 4 out of 5. I thought nalang I’d have to experience that rin naman one way

or another, syempre in this profession.

R: Next, despite your loss, have you been able to find any benefit from your experience of the

loss? Rate using a 5-point Likert-type scale, 1 (no benefit) to 5 being (great benefit).

Participant: Ganon pa rin. I guess parang mas pinrepare niya ako for other future mortalities that

may happen. It helped me on what I can do possibly prevent it. Also, yung sa emotions din, ito

kasi yung pinakagrabe eh so, parang I guess may benefit. I don’t really want to think of it as may

benefit pero oo nga parang meron nga naman.

R: Overall, do you believe that you have changed as a person since that experience of patient

death? If yes, in what ways?

Participant: Yeah, for sure hindi ko to makakalimutan. Pero parang hindi naman sobra, medyo may

change pero hindi naman sobrang laki. I guess it just opened my eyes to like possible situations na

maeexpose kami as a doctor. Pero like super laking change hindi naman.

H6.

Participant 61 (23, Female, Metro Manila)

Nurse

Years in profession: 2 years

No. of Patient Deaths: > 20

HGRC Score: 2.08 (High)

SCS-SF Score: 3.33

GMRI Score: 3.39

R: Before we jump into the specific research questions, can you tell me about yourself?

Participant: Uhm, I’m on pain management and palliative care nurse in Makati medical center.

So I graduated last 2016 in nursing.

R: Bakit yun po yung napili niyo?

Participant: Ano parang bata palang ako okay na yung nursing sakin so pinursue ko lang siya

nung college and then parang pre med course siya kasi mad memed ako this coming year. So

ayun, nadelay lang ng konti.

R: Ilang years na na nurse po kayo?

Participant: Phree years na pero yung working experience ko is two years palang talaga nang

April.

R: Buti po sa palliative care?

Participant: Actually, nag volunteer lang ako kasi paraing kakaiba lang siya hindi siya sobrang

broad.

R: How do you see yourself as a nurse po?

Participant: I can see myself as a nurse na I think I’m okay naman and I’m competent naman.

My patients love me naman.

R: Ano naman po yung mga best aspects of being a nurse po for you?

Participant: Being a nurse within my area yung best aspect is we deal with all cases since pain is

present in all ages and human beings, so we handle all cases, cancer, post operative. So I think it

is an advantage that we handle all patients needs ganun.

R: What about the most difficult aspects naman?

Participant: Most difficult aspect samin is when the family is getting attached to you tapos you

get attached to them. Within our care when the patient was referred to palliative care. That’s the

time we provide comfort to those dying, ganun so we just treat yung pakikipag deal with the

family and not only with the patient.

R: So ganun po hindi ganun ka tagal under your care?

Participant: Depende some patients take months, yung iba years ganun sa mismong hospital. And

sa unit namin kasi referred sila so minomonitor namin sila.

R: Next question naman po is yung sa research naman po talaga namin. On average how many

deaths of patients do you deal with on a weekly basis, and if not weekly po on a monthly basis?

Participant: Siguro monthly around ten? Or more ganun. If weekly naman, a week will go by and

wala. Depending on the patient’s case kasi.

R: Now naman po I want you to think of a patient’s death that was particularly difficult for you.

Can you describe the patient. And when did this happen?

Participant: Since nurse na ako the most difficult patient I handled was my mom. She died nung

andun ako. She was under my care. That was the most difficult one for me. Tapos before I entered

palliative and pain care in Makati med I was really grieving for the loss of my mom cause I

considered her as a patient. 24/7 nasa hospital ako so mga care kay mama and nag aassist din ako

sa hospital.

R: Kung san po kayo nagwwork dun din po yung mom niyo po?

Participant: Ah hindi. Namatay si mama sa Makabali tapos nag stop ako mag work kasi para siya

yung maalagaan ko. Tapos after yung death ni mama mga siguro after a few months nag apply ako

sa Makati med.

R: If sa makati med naman po. Meron po bang patient na siguro na you can consider as second

difficult?

Participant: Oo, actually marami kasi almost lahat sila for palliative service na ganun. For pain na

then na re admit tapos yun na yung last step nila until death. So minsan within months nakikita mo

sila everyday tapos maaattach ka sa family, iinvite ka nila to dinner tapos they encourage you sa

care ng patient. And pati yung mga problem with the family nag oopen up na sila sayo. So that’s

very difficult for us. Tapos yung compliance niya sa care kasi mostly bukod sa physical aspect ng

care mo you deal with the emotion, mentality ng patient. Sometimes makikita mo yung experience

ng family ganun. So mahirap na pag naisip mo na what if sayo nangyari ganun.

R: So yung namention niyo nga yung most difficult aspect is yung sa mom mo and those under

your care. Naaalala niyo po ba yung what you feel during the experience?

Participant: Oo. First yung the day na nawawala si mama parang blank lang. That was two years

ago. Sobrang blank lang, parang di siya nagsisink in sakin yung level of grievances. Kasi

naeexperienc mo pa kasi yun. Siguro more than a year din before maaccept although sa mga

patients din ganun pag nawala yung patient parang okay di ka sanay pero ngayon parang nasasanay

ka na. Pero malungkot parin knowing na naexperience ko yun tapos nakikita ko yung family ganun.

R: What about after naman po? May ginawa po ba kayo para makapag cope with the experience?

Participant: Dun kay mom ko I isolated myself muna. Parang I dont know what to do kasi since I

was so depressed until na mag decide ako na to work again na I’ll try again. Medyo parang naging

damaging siya kasi over and over nakakaexperience ako ng death. Nakikita ko yung ano yung mga

patients ko namamatay, nakikita ko yung sarili ko sa other families.

R: May times ba na naaalala niyo siya?

Participant: Oo. Kapag ganon parang isolate ko ulit muna sarili ko kasi naiiyak ako ganun.

R: May instance po ba na same situation yung sa mom niyo yung sa other patients yung pag handle

niyo?

Participant: Oo parang yung manifestations ng syptoms ganyan. Yun yung mga nakikita ko sa kay

mama ko tapos yung maffeel ko na like I should’ve done better before. So ayun parang over the

time nakakamove on naman and nakakacope up naman so I try to improve.

R: meron po ba kayong particular na ginagawa, like do you talk to your peers, your family ganun?

Participant: oo. Nung sobrang down ko medyo mahirap humanap ng peers na makikinig sayo. But

there was one was person who was unexpected who helped me go through all of this. Kasi muntik

na ako mapunta sa mga psychiatrics non. Sakanya ko nafeel na di ka ijujudge ganun. Pero ayun di

naman na umabot dun kasi friend ko siya nung college so mas nakakapag open ako sakanya. Since

ngayon yung mga kawork ko rin, most of the time nga kami kami na yung naguusap sa loss ng

patient.

R: In what way of this loss of this patient did this affect you emotionally?

Participant: Emotionally it really affected me. Devastated ako, I was really depressed with sa mom

ko. Pero with the following na mga deaths sa mga patients parang sometimes I feel na wala na,

nasasanay na ako. When we reflect back na parang what if kami nga yun. What would my family

feel? I’d feel bad again tapos pero ganun. Yun nga time heals.

R: During that time po how did your grief look like? Umiiyak po ba kayo? Sobrang down po ba

kayo?

Participant: Uhm no, sobrang down lang talaga ako, sorbang empty nung feeling ganun. Tapos

may times na umiiyak ako when I open up sa friend ko pero may point na kasi na ayaw ko na

umiyak. Tapos ngayon sa patients minsan naiiyak ako kagad.

R: Pero kailan po naiiyak? Kapag kayo nalang po mag isa? Pag naaalala niyo po?

Participant: Oo. Usually pag ako mag isa kasi pag meron ka kasama na other people parang

magmemerge ka dun sa vibe nila kasi hindi pwede iisolate mo yung sarili mo. kailangan

collaborative with the team.

R: What about professionally naman po? Ano po yung effect niya? Bukod po dun sa nag stop kayo.

Participant: Professionally naging careful tapos sometimes you question yourself na am I enough

ba kasi over time naman nawowork out naman. I consider myself parin na dapat mag improve, na

I wasn’t able to give it to my mom bigay ko sa other patients.

R: So sa level of attachment naman po with your patients, may nagbago po ba?

Participant: Oo. Ngayon mas manageable na professionally. Hindi ko na masyado iniinvolve yung

emotions ko sakanila. Kasi pag mas mabigat kasi siya pag ininvolve mo yung emotion mo sakanila

and yung life mo. deal with it nalang, absorb mo lang tapos magkalabas mo labas mo.

R: Yung motivation niyo naman to go to work naman po?

Participant: Motivation to go to work syempre when I see my patients na nahihirapan tapos parang

nakikita ko sila na need ng care motivated naman ako. May times naman talaga na pumapasok ako

hindi para sa sweldo or sa work kundi para sa patients ko.

R: Yung sa naaalala niyo po na yung sa scale namin. Its about self compassion po. Na being

compassionate to oneself in times of difficulty, failure, patient death po. Naaalala niyo po ba yung

experience niyo during answering the scale?

Participant: Actually, hindi masyado kasi sobrang dami nga

R: Pero yung tanong ko lang dun is what do you think is the role of self compassion on handling

patient death and lalo na po kayo na sa palliative care na po na marami rin namamatay.

Participant: Self compassion like yung self love ko?

R: Opo, being kind to oneself kunwari yung namatayan kayo ng patient you reassure yourself na

you can only do so much, etc.

Participant: Oo kasi terminally ill na yung mga patients na nahahandle ko so kapag ganun hindi

mo iniinvolve yung sarili mo and hindi maattach ka at some point. Uhm parang you make yourself

feel lighter, you try to convince yourself na this is what I can only do ganun. And syempre since

nurse ka, although you have other interventionals in mind na kaya mo gawin sa patient mo without

the doctors order sometimes limited parin. Lahat ng concerns ganun binibigay ko sa mga doctor.

Tapos if wala na talaga na mageexpire na yung patient parang at some point you console yourself

din na parang okay lang kesa sa nahihirapan yung patient. At least I provided yung comfort care.

Nag expire yung patient peacefully, hindi nahihirapan. So parang kapag parang hindi ko na

masyado biniblame sarili ko. When you did your best naman for the patient parang ayun na yung

consolation mo para sa sarili mo para di ka maguilty sa nangyari.

R: How do you balance your emotions with your responsibilities as a nurse?

Participant: Sa ngayon when I feel burnout na ako emotionally kasi inaabsorb mo yung negative

vibe, I take a break talaga, like inaalis ko yung sarili ko sa work tapos 1 minute or 2 minutes

kinakalma ko muna sarili ko and then ayun back to reality. Kasi you treat each patient kasi

individually ganun. So depende ganun sa mood nila, sa ugali nila. Magaadujst ka sakanila, hindi

pwede yung ugali mo for them. Yung ugali mo sa other one iba sa ugali mo sa other one.

R: Regarding meaning making naman po is yung giving sense to an event na yung meaning po ng

event na yun sa sarili mo is when it happened ano po yung binigay niyo po na reason as to why it

happened. Yung you reassured yourself na there’s a reason as to why this happened. It’s possible

rin I can get benefits from the experience. Yun po parang ganun. How much sense of the loss have

you made?

Participant: Yung first time ko yung is sa mom ko parang most tragic talaga na loss sakin. Actually,

hindi ko mahanapan ng reason, yun yung parang maghahanap ka talaga ng reason behind it

hanggang maghahanap ka ng reason sa sarili mo tapos devastating. So ngayon yung reason behind

it is di na ako masyado naghahanap through the course of nature it really happens na talaga. Like

everyone ends up dead naman. So usually ganun darating tayo sa ganun may nauuna lang and then

sometimes bad yung experience nila with death minsan naman comfortable naman sila in passing.

R: If you dont mind me asking, ano po yung ikinamatay ng mom mo? Was it so sudden lang po?

Participant: No naman, parang expected din pero kasi sa brachial hemorrhage si mama tapos

parang one week lang siya sa hospital dito. From UAE nagpunta dito. After dito nagkaproblem

kasi with the nurses and sa tracheostomy site. Tapos so ayun, after ng incident na yun nahirapan,

yung complications kay mama over the time na maraming drugs na iniinduce kay mama nag give

up yung mga organs niya so yun. Parang at that time nagpaalam narin si mama, parang expected

narin ni mama.

R: Yung about sa other patients naman po, what do you think are the other factors that made their

death more difficult than the others po? For example po yung sa mom niyo, lalo na family, parang

you question yourself na baka meron akong nagawa. Ano po bang factors that make a death

difficult?

Participant: As observed ko ah, kasi sakin ngayon nung mauuna ako sa pain and palliative care,

pag may namamatay sobrang iba yung dating sakin. Alam kong mahirap siya ganun nung una

hindi naman niya deserve na mawalan kahit sino. Pero over time naman parang okay nalang siya.

Hindi ka na emotional. Ano pa ba? Age din siguro. Usually meron kami cases na bata during

twenty plus tapos nasa palliative care na siya tapos unresponsive na. Kita mo kasi how difficult it

is for the parents na mawala. Usually mahirap lang talaga siya kapag nakapag deal ka na sa family.

Yun kasi yung family mo kasi yung kailangan intindihin hindi na yung patient masyado kasi yung

patient minsan nagiging weak na pero yung family fighting parin. Yun yung pinakamahirap is

pano mo iddeal and pano mo sila iseset sa reality.

R: So despite the loss po would you still say na you were able to find benefit from the experience?

Participant: Parang wala,with all the losses ah. Siguro samin kasi kay mama ko wala ako nakita na

benefit sa loss dun eh. Pero ngayon parang okay na na you get over it without finding any reason.

Pero sa other patients ko as observed ko parang yung benefit dun if sobrang baon na sa utang. Pag

nag expire na yung patient, dedeal nalang nila with the expenses. family problems.

R: Ano naman po yung role ng meaning making sa handling ng patient? Like yung pagbibigay po

ng reason.

Participant: Actually doctor na yung gumagawa nun, yung meaning making. Sila magsasabi ganito

yung extent ng patient, terminally ill na. Samin support lang mostly ganun. Hindi talaga kami yung

nagbibigay ng meaning making.

R: Would you say na mas nakaka interact niyo yung family more than the doctors?

Participant: Oo. Kasi yung mga doctors hindi sila 24/7. Although yung mga consultant kasi

although ikaw you do rounds and you spend time. Kailangan nila yung time mo so pag pinatawag

ka pupunta ka rin para iaddress yung concerns nila tapos iiyakan ka nila. Tapos wala naman sila

concerns iiyakan ka lang.

R: Kung ididifferentiate niyo yung tingin niyo na role sa mga pag handle ng patient hindi nalang

po yung sa patient death nila. Ano po yung pinakamalaki pong difference from experiences as a

nurse as to doctors po?

Participant: Ano kasi we deal with it differently. Iba kasi yung training ng doctors sa nurses. Mostly

sabi ng consultant na lagi namin kasama kapag nagrrounds is pag nurse ka you are trained to give

care talaga, support talaga. Pag doctor ka you train on how to manage the patient medically. So

parang yung other doctors naneneglect na yung patients and families. Yung wholeness ng family

and other factors kinoconsider talaga ng doctor pero not so much kasi present sila dun sa symptoms

na kailangan nila itreat. Pag sa nurses talaga mas gentle yung care.

R: Do you believe that you have changed as a person because of that particular experience po yung

sa mom niyo po? Do you believe you have changed po?

Participant: Oo naman, kasi when nandito si mama sobrang dependent ko sakanya and ganun.

Parang ngayon ive been stronger with all the losses. Once naattach ka you get the good parts lang

and not the bad parts. Meron nachachange parin talaga on how you view life and how you deal

with things.

H7.

Participant 17 (41, Male, Pampanga)

Medical Practitioner (Anesthesiologist)

Years in profession: > 20 years

No. of Patient Deaths: > 20

HGRC Score: 1.37 (Low)

SCS-SF Score: 3.75

GMRI Score: 4.00

R1: Can you tell us a little bit about yourself before we jump into the specific research questions?

Participant: Osige. I’m Dr. [redacted], Anesthesiologist na naka-assign dito sa [redacted] Hospital

and all other hospitals dito sa Pampanga. Uhm, I’ve been practicing for more than 10 years in the

field of medicine. Tapos, I’m a family man with three kids. Uhm, I live ahhhh… in San Fernando,

at San Fernando, Dolores, and my favorite color is blue (laughs).

R1: San po kayo nag-start as a doctor?

Participant: Actually, I graduated from Angeles University Foundation. Even my pre-medicine

years, uhm, dun din ko kinuha, BS Medical Technology, tapos I’m a registered medtech. Tapos I

also graduated with my medical degree dun sa Angeles University and I’m also a registered nurse.

R1: Kailan po kayo naging anesthesiologist?

Participant: Three years ago yan.

R2: Pwede pong malaman bakit naisip niyo pong anesthesiology?

Participant: Anesthesiology is? Uhmmm, well, anesthesiologist kase is not that ano, is not that the

popular subspec(ialty), pero, mas, if the subspecialty is not popular, meaning konti lang yung mga

ka-ano mo diba? Onti lang yung ka-ano mo sa field. So, okay naman, very happy naman, serving

patients.

R1: Ohh first question po, how do you see yourself as a medical professional, as a doctor?

Participant: See myself? I see myself… being a doctor as long as I can serve. As long as my health

permits (laughs) ah ano kasi yung doctor eh vocation yan eh, di ka naman yayaman diyan sa pag-

dodoctor. Kung gusto mo yumaman, go into business. Sa doctor kasi, ano yan eh, kunyari, being

anaesthesiologist, kung, ahhh, parang, incidental nalang ang bayad, kunyari if we have patients na

vehicular accidents tapos we’re called to serve sa surgery ganyan. Di naman inaaa-, di naman

namin ineexpect na mabayaran ka e, di mo naman alam kung may pera yung ano. Pero yung ano,

may oath kami kasi na... kailangan mo i-attend dun sa pasyente, pupunta ka di mo man alam kung

may pera yung pasyente so okay lang kung nabayaran niya pag wala, wala.

R2: Tapos, ayun po, ahhh, what are some of the best aspects naman po of being a medical

professional or a doctor? Ano po yung..

Participant: Best aspect?

R2: Opo.

Participant: Fulfillment ng mga salita. Fulfillment na sasabihin ng mga pasyente sayo na “Doc,

thank you po. Okay na po yung pakiramdam ko, thank you po” Either speaking.

R2: Average po sa isang ilan yung mga nag-gaganun?

Participant: Kami kasi, we’re not that ano sa pasyente. Konti lang. Kunwari, we do two, three,

depende, two, three, hanggang six to eight cases a day, pero okay na yon, okay na yung dalawa,

tatlo.

(A colleague of the interviewee came during the interview)

Participant: Andali lang ah. Yes, doktora? Mga ano.. Nagthethesis.

R2: Good morning po.

(Colleague talks with the interviewee)

Participant: Okay. Sige, continue. San na ako? Nawala na ako.

R2: Ayun po. After ng parang magagandang aspect po, sa tingin niyo ano naman po yung mga

most difficult aspects po?

Participant: Most difficult? Sa profession namin, sa specialty namin, wala kang oras. We’re called.

We’re on-call 24 hours. Natutulog ka with your family bigla kang tatawagan, may bakasyon ka..

Although pwede mo siyang ano, minsan nasa mall kami, tatawag sila, kailangan mong puntahan

(laughs) diba? Tapos para sakin yun yung ano uhhh sa profession naming anaesthesiologists yung

ibang supspec(ialty) kunwari internal medicine, pwede nila i-schedule. May clinic hours sila e, so,

hawak nila yung oras, kami hindi namin hawak yung oras

R1: On patient death naman po, on average how many deaths of patients do you deal with, on a

weekly basis?

Participant: Weekly basis? Ahhhh nung ano, when we were in training, uhm, kunyari kasi before

ka mag-practice diba four-year medical course, third year, fourth year ka naka-expose ka sa

hospital, so, halos dun na kami nakatira, so everyday may namamatay, halos. (laughs) Kase, yung

JBL, sa big hospital, big hospital yan e. So lahat ng mga, mga mahihirap na case lalo na mga

indigent dun nila nilalagay.

R1: Ahh opo.

Participant: kase hirap sa financial yung patients, halos araw-araw. Alam mo pag, nung una,

nakaka-ano ako ng death, yung una yung parang nung first, first week ko sa hospital, siyempre

pasyente ko e, e namatay siya, hmmm, pati ako umiiyak, umiyak ako.

R1: Naalala niyo pa po yun kung bakit siya namatay?

Participant: Ah terminal ano. Terminal case siya. Malubha siya. Kasi talagang expected na. Pero,

umiiyak yung kamag-anak, tapos pati ako na-carr--, naiyak kase I’ve been caring for the patient.

Tapos, bukas nanaman, may namatay nanaman, parang one week, araw-araw umiiyak ako,

nagsawa akong umiyak. (laughs) eh siyempre pasyente, kaya nga araw-araw may namamatay,

nagsawa akong umiiyak. Araw-araw nalang umiiyak ako? (laughs)

R1: What about ngayon po?

Participant: Ngayon? Uhhh ngayong private practice. Di pa ako namatayan. Yung ano, when I was

in training, siyempre yung mga vehicular accident ng masyadong malubha. Oo, namamatayan pero

as long as na ginawa mo yung dapat gawin sakanya, wala kang regrets.

R2: Ano po yung parang exactly na naffeel niyo kapag kunyari ayun po na namatayan kayo ng

pasyente?

Participant: Sayang. Sayang yung life. Hippocratic oath namin to extend life. Kaya lang ayun.

Tapos ano, you have to deal with families. Yung emotions ng families. Ikaw yung maghahatid ng

news sa kanila na wala na yung loved ones nila. Mahirap din.

R2: Ano pong ginawa niyo after nung experience? Parang nung naexperience niyo po na ayun nga

sayang, ano pong ginagawa niyo?

Participant: Uhh. pag may namamatay, always pray. Tapos, pinapalanangin namin na, wala na

sanang mangyaring ganyan pero di naman maiiwasan.

R2: Eh ano naman po yung parang, pano pong nag-cocope po kayo with your feelings and syempre

nalungkot po kayo non.

Participant: Kagaya nga ng sinabi ko sainyo, as long as you made yung kailangan naming gawin

R2: parang nirere-assure niyo po yung sarili niyo?

Participant: Oo. Maa-ano ka kapag may kulang kang ginawa e.

R1: Opo.

R2: Oo nga po.

Participant: “Sana ginawa ko to”. Pero kung ginawa mo naman lahat, wala. Okay lang.

R1: If meron pong isang patient na, yung naaalala niyo po ng sobrang, sobra-sobra po yung pag,

sobra-sobra po kayong naapektuhan dahil sa death niya. May naalala pa po ba kayo? Like think of

one particular patient po.

Participant: Sobrang naapektuhan? Nung namatay yung kapa-, yung kapatid ko ng dengue.

R1: Kayo po yung nag-aano sakanya?

Participant: Mhmmm. Hindi naman ako yung attending physician. Pero doctor na ako nun. Ganito,

ako dapat kasi yung bunso e, pero parang, in-entrust samin, binigay samin yung angel, yung

kapatid ko, babae yun e tapos siguro 9 years old siya non, ayon, dengue, then di gaanong medical

intervention, di siya, anong tawag, di siya nagrerespond, blood transfusion, experimental drugs

from abroad, dinala na namin dito, she died sa UST kasi. Ganito ang nangyari nun. Kausap ko lang

siya ah. Kausap ko siya sa NICU, parang ICU ng mga bata. Hawak ko siya. Tapos sinabi niya,

nagkukwentuhan lang kami. Tapos, “Kuya, kuya, nahihirapan akong huminga.” Yun yung sinabi

niya. Tapos bigla na siyang.. As in parang tinurn-off mo light. So lahat ng medical don, yung mga

doctors don nagtatatanong, “Anong nangyari?”

R1: Ano po yung--?

Participant: Di man lang nga yung pababa. Medyo naghihingalo. As in parang in-off mo yung ilaw.

Tapos biglang ganun, Tapos revive, revive, di na siya na-revive talaga.

R1: Ano po yung na-feel niyo non?

Participant: Ayun. Jusko! Umiyak ako. Parents ko umiiyak, Tatay ko umiiyak. One year yata bago

naka move on. (laughs) Araw-araw nasa sementeryo yung tatay ko. (laughs)

R1: After po nun. Ano po yung nafeel niyo after?

Participant: Nalungkot. Parang, diba, doctor kami, nanay ko doctor, ako doctor, bakit nagkaganun?

Pero, ayun nga, ginawa naman nila lahat e

R1: Opo.

Participant: Ginagawa naman ng mga doctor yung kailangan gawin. Time siguro that God has

plans for everything.

R1: Uhm. May ginawa po ba kayo to cope with what had happened? Like?

Participant: To cope with uhm...

R1: kausap ng family?

Participant: mhmmm (nodding) yon usap mhmmm always pray [INAUDIBLE]

R1: kailan po yung nangyari?

Participant: [INAUDIBLE] siguro ano yon ewan ko 2005?

R1: may mga 10 years na po ba?

Participant: Mahigit na.

R2: Pero ano po yun parang in what po kayo nagrieve? Like ano po yung mga... kasi po may ibang

tao na kabang ganun di nakakain ganyan, nahihirapan matulog, kayo po? Ano po yung mga

nangyari sa inyo?

Participant: Uhmmm. Di nakakain? Hindi naman ako umabot sa point na yun. Ano lang naiisip

mo lang. Minsan pinapalangin ko na mapaniginipan ko siya na kakausapin ko.

R1: Mga gaano po katagal would you say na nag-grieve kayo?

Participant: Nag-grieve? siguro ano.. yung iniisip ko lang.. uhmmm . a month ganon? That time

naiisip ko pa sana mapanaginipan ko siya yon. Kahit sa panaginip lang. tapos di naman ako

naniniwala sa pero san makita ko siya (laughs) di naman ako matatakot basta nagpapakita siya

sakin

R1: Ahhh opo opo. If sa ibang patients, tingin niyo po ano pa po yung other factor besides sa

kapatid niyo nga po siya and ano may iba po bang factor bakit sobrang hirap po para sainyo like

yung age yung sakit po niya any reason for that?

Participant: Reason for that? inisip ko lang parang masyadong maaga?

R1: So yung age po?

Participant: Oo parang masyadong maaga siyang kinuha ni lord.

R1: Tsaka unexpected din po na..

Participant: Oo, unexpected talaga. ehhh nadengue siya e

R1: Next naman po, in what way if any did this death of a patient affect you emotionally?

Participant: Emotionally? di na naman ako down na down emotionally sana lang nga sinasabi ko

sainyo sana lang magparamdam siya sakin sa panaginip ko okay na siya [INAUDIBLE] ayon e

close naman kami, close kaming lahat sa kaniya

R2: As a doctor po, paano po siya paano po yung experience niyo po na yon naapektuhan?

Participant: Uhmm ang nangyari parang naging, parang naging lalo na sa family members, pag

may lagnat, kase minsan na-o-osige, lagnat lang yan parang nung una, biogesic muna paracetamol,

ngayon.. parang pacheck ka agad dugo [INAUDIBLE] platelete, pacheck kaagad parang iniisip

mo kaagad baka dengue to diba? kahot yung mga anak ko pag nilagnat na sila kaagad check,

although hindi naman kami nagkulang sa ganun sa kapatid ko ehh nangyari... pero ngayon parang

ay nilalagnat pa laboratory mo pacheck mo baka may dengue diba

R1: Sa way naman po you treat your other patients may nagbago po ba?

Participant: Treat other patients? Hindi nagbago. Wala, pero kung sa paggagamot mas naging

careful ka.. mas palagi mong yung suspicion mo na pag nilagnat dengue na ba (laugh). Ganyan

yung mga doctor, pag namatayan ka na...

R2: Ahh.. personally naman po? paano po kayo naapektuhan sa mga patient loss na naexperience

niyo? Like changes po sa lifestyle ganun?

Participant: Papano ako naapektuhan?

R2: Values niyo po ganun? pwede din po

Participant: Values ko? Oo, like yung sa ano, treasure mo yung life mo basta itreasure mo yung

life kung ano magagawa mo ngayon gawin mo na kasi di mo alam kung anong anong mangyayari

bukas kahit sa anak ko sa mga anak ko pag may mga parang parang may mga significant na events

sa life nila i'll try na di ko mamiss ahh e simple graduation, recognition day.. ahh anung tawag..

recital nila sa ballet sa dance sa ano dapat nandun ka kasi treasure mo yung life e, di mo alam kung

ano mangyayayari, kami, ako sa pasyente ko minsan sasabihin ko kailan po kayo huling

nagpacheck ng dugo? "ay matagal na doc" sampung taon? five years? sasabihin ko "tay kayo palagi

niyong iniisip yung mga kapakanan ng iba, pag birthday niyo" sabi ko "birthday gift niyo sa sarili

niyo, magpacheck up kayo" (laughs)

R2: Oo nga po tama.

Participant: Diba? minsan iniisip niyo yung ibang tao tapos yung sarili mo di mo naiisip yun yung

birthday gift yun yung binibilin ko sa pasyente, pag birthday niyo, patingin kayo pacheck niyo.

R1: Ahh after yung mga expereinces niyo po na parang ever since po na parang ever since

naexperience niyo po na namamatayan ng patient? May nagbago po sa confidence niyo as a

doctor?

Participant: Confidence? Hindi naman siya bumaba. as a doctor kasi, kailangan mong i-update

yung sarili mo, kasi hindi kami, pag natapos hindi ka naman pwedeng maging stagnant e

kailangnan kaming yun yung problema.. yun yung di nakikita minsan na ng mga tao na yung mga

doctor minsan kahit tapus na yung trabaho nila nagbabasa parin sila pagkatapos para sakanila diba?

minsan matutulog nalang ako magbabasa pa ako ng mga journals, updates.

R2: Opo.

Participant: Diba? di nila alam.. minsan di nila makita na (laughs)

R1: Na nag-aaral po?

Participant: Nag-aaral parin kami. (laughs) sila natutulog na, kami, matutulog na ako, mag-aaral

pa ako. magbabasa pa ako ng mga kase di pepwedeng ihuli yung ano mo.. yung kung anong bago..

R2: Ohh opo.

Participant: Para sa mga pasyente mo, sana marealize nila yon

R2: Pero.. ahm.. katapos po ng mga experiences ninyo pano niyo po nasasabi na motivated parin

kayo na pumasok sa trabaho ganun.

Participant: Ahh motivated ako.. everyday pumasok sa trabaho kasi mas lalo kang kailangan e.

yung mga doctors? kulang. mas lalo kang kailangan. pag nawala yung kunwari dito sa hospital pag

nawala yung isang doctor, kunwari yung absent analaking epekto sa hospital, kunwari nagka sakit,

ang laking epekto sa hospital, kase maiistress yung isang kunyari dalawa kayong doctor yung lahat

ng pasyenta mapupunta sa kanya e tao rin yan, tao rin kami napapagod minsan yung thinking mo

napapagod din, napapagod din yung utak mo e diba so kahit na gusto mong bigay yung best service

mo best ano mo pagod ka e so ayun

R2: Yung ano po, pano yung level ng attachment niyo with your patient kase kunwari po nung..

yung first experience niyo po ahh nakaramdam kayo ng.. yun nga po nalungkot kayo.

Participant: Oo.

R2: Eh yung susunod niyo pong patient ganun

Participant: Ganun parin. basta nagbibigay ka ng care sakanila pareho lang din di nagbabago

R1: Pero yung lungkot niyo po di naman po siya naglalast ng matagal?

Participant: Hindi. Para sa akin kasi talaga basta binigay mo yung due para sakanya walang.. di ka

papagalitan ng sa taas pag may nagkulang ka dun ka ano, pero kung kung binigay mo yung ano

sakanya.. mga kailangan ibigay sakanya with your resources di ka papagalitan ni Lord. (laughs)

R1: Ahh. Next naman po is self-compassion. What do you think is the role of self-compassion po

on your life as a doctor?

Participant: Self-compassion?

R1: Yung being compassionate towards self in time of failures, difficult times, parang pag reassure

niyo po sa sarili niyo na “okay lang yan.. tao ka lang” ganun po.. ano po yung role non sa pagiging

doctor lalo na po sa paghahandle ng patient deaths.

Participant: Mhhhm paghhandle ng patients?

Participant: Kailangan yon, kailangan yung self-compassion tapos, kase.. ano ba.. define mo nga

yung selfcompassion ulit?

R1: Being compassionate to oneself po.

Participant: To oneself?

R1: yung parang yung thinking niyo po na for example kapag may nangyaring masama.. ahh

instead of masyadong dinadamdam, ginagawa niyo po is parang iniinternalize niyo na okay lang

hindi ikaw yung may kasalanan.

Participant: Hindi ikaw yung may kasalanan.. oo.. uhhhhhm.. parang ano yun, mindfulness diba?

tama ba ako? mindfulness ahhh self-kindness, tama ba?

R1: Opo.

Participant: Kailangan yon as, as a medical professional, kami kailangan maging sensitive lahat sa

mga, sa feelings sa mga, sa kung anong dinadaanan ng pasyente, minsan kasi yung pasyente

kunyari sabihin natin na "okay pa lang yan e, kanina okay pa lang yan e bakit ngayon patay na"

kailangan mong mafeel yung ano nararamdaman ng family niya ang approach ko kasi diyan

kunwari "anong nangyari? kausap ko palang kanina yan bakit siya namatay" pag ganyan wag mo

ng sabihing "time na po niya kinuha na siya ni lord" hindi kailangan sensitive ka feelings ng iba

ang approach ko jan ganyan "naiintidihan ko po yang nararamdaman niyo" ganyan "meron po ba

akong maiitutulong sainyo magaling po akong makinig" pag ganyan explain mo na yung mga

naexplain mo dapat tapos [INAUDIBLE] "kailangan niyo po ba ng konting privacy or kailangan

niyo po akong magstay dito sa harapan niyo" ganyan mas naappreciate nila yon.

R1: Kapag ganun po pano niyo po nababalnce yung emotions niyo and yung responsibilities niyo

po as a doctor?

Participant: Emotions and responsibilities? Uhm. we try not to be ano maapektuhan lahat sa

nangyari sa hospital, tao rin kami, kunyari, di mo maanong malungkot ka sa bahay, may nangyari

sa bahay, lahat ng kamalasan nangyari, pero kapag kaharap mo yung pasyente, di mo pwedeng..

trabaho ay trabaho, yung deserve niyang care bigay mo sakanya. kalimutan mo yung mga, mga

nangyari sayo sa bahay, malungkot, nawalan ka ng tubig, naputulan ka ng tubig, naputulan ka ng

kuryente

R2: So ano naman po parang how much sense would you say you have made of these losses?

parang throughout dun sa experiences niyo na yon parang paano niyo po binigyan ng sense?

Participant: Hmm kapag kasi tuwing namamatayan ang naiisip ko eh we have to... we have to

strive, we have to, yun nga sinabi ko sainyo we have to update ourselves, regularly, na the best

care na available ngayon na mabibigay mo kase yung paggagamot natin iba na siya ngayon, lalo

na high tech na tayo ngayon so ahhhhm kunyari may namatayan ka sa hospital na kailan yung

gamit, kunyari wala yung gamit, ngayon na pwede sanang makatulong sakanya sa ano, kami, wala

kaming gagawin ibili natin to, irequest natin to, sa pasyente yan, para sa susunod, may nangyaring

maganda, mas maganda yung chances na masave

R2: Parang personally po, paano niyo po minemake sense na namatay na yung patient niyo? Ano

po yung meaning nung death niya na yon para sa inyo?

Participant: Meaning ng death na yon para sa akin? uhhhh. ako kasi yung meaning nung death

ganito kasi yan, people die everyday. so nalulungkot ka namatay siya nalulungkot ka dahil nawalan

ka ng pasyente, hindi. meron kasing taong masyadong naapektuhan sa pagkawala ng pasyente na

hindi sila nakakabalik, may kilala akong mga doctor na ganyan, di sila nakabalik sa profession nila

masyado, ang iniisp ko naman, kailangan mong, malungkot ka pero wag kang magdwell dun sa

pagkamatay niya, kasi mas kailangan ka pa ng ibang tao, in times na need ka nila diba, e kung

doctor na yun na hindi nakapag cope up siya lang yung doctor sa barrio, edi wala ng titingin sa

kanila, you try to be strong, family, prayers yon.

R1: So despite the loss po masasabi niyo po ba na may benefit kayong nakuha from the experience?

Participant: Hmm mhhhm, may benefit na ano, yung sinabi ko sainyo mas mag aaral ka. Mas

iimprove mo yung self mo kung tamad kang ano nagaattend ng seminar ng updates, sisipagin ka

kase ayaw mo mangyari ulit yon anf mahirap kasi may bagong updates na gamot na pweding

ibigay, nung time na yon di mo alam meron na palang ganon diba? so kailangan updated ka hindi

mo siya alam, dahil hindi ka nag update yun yung benifit mas lalao kaming nagaaral pag natutulog

na kayo nakagising pa kaming nagbabasa.

R2: Pero ayun po sa tingin niyo po ano po yung parang use or role pagbibigay meaning sa death

po nung patient? ano po yung maitutulong non?

R1: Anong role naman po ng knowing how to give meaning to a death of a patient sa pagiging

doctor?

R2: Sa tingin niyo po ano po yung role nung pagbibigay niyo po ng meaning na maimprove niyo

po yung sarili niyo sa pagiging doctor, san pa po siya makakatulong?

Participant: For me yung role niya is dahil sa death na yun makakatulong ka kung isshare mo yung

ano.. Kami kasi ganito, sa hospital pag may namamatay , or may [INAUDIBLE] meron kaming

conference ang death ng pasyente sa hospital, di lang death certificate, ang hindi niyo alam, kunyari

sa isang hospital sa san fernando, dinidiscuss yan, meron kaming tinatawag na morbility-mortality

conference, ibig sabihin yung pagkamatay ng pasyente, ididiscuss yun dun sa community, lahat ng

doctors yan, magaattend ng isang conference halos monthly, kase id-dissect namin lahat ng

nangyari sa pasyente leading dun sa death niya so ikaw kunyari naexperience mo yung dinidiscuss

mo yung pasyente, yung ibang doctors malalaman nila yung experience mo malalaman nila, ano

nangyari, para pag sakanila nangyari yon alam nila yung gagawin nila, "ay yan yung diniscuss

nung ano" kase iaano namin paguuusapan namin yung gagawin anong treatment na ginawa, may

magssuggest na pwede nating gawin to, ganon, so yun yung meaning na ipass mo yung experience

mo sa iba, sa ibang healthcare providers para kung meron silang maencounter na ganung

circumstance alam nila yung.. mas alam nila gagawin nila diba?

H8.

Participant 112 (24, Female, Metro Manila)

Post-graduate Intern (Senior Intern)

Years in profession: 9 months

No. of Patient Deaths: 11-20

HGRC Score: 4.16 (High)

SCS-SF Score: 3.50

GMRI Score: 3.22

R: Can you tell me a little bit about yourself po?

Participant: Okay, ahmm I’m currently a Post-Graduate Intern having my internship here in a

public hospital in Manila. I graduated last year sa University of Santo Tomas. So iyun, yung

currently kong ginagawa… ahhmm… when I am off-duty, I catch up with my friends, surfing the

net, ganon. Tapos nag-aaral na rin ako for boards this September, ganun lang naman.

R: Goodluck po (laughs). Ahh to start po, how do you see yourself as a doctor?

Participant: See myself as a doctor… aah hardworking, ahhm sensitive to other people’s needs,

tapos resilient din, kasi kapag meron akong masamang feedback na napapansin ng mga teachers

ko, ayun lang naman.. so, for, kaya anything than hardwork is the cornerstone of being a good

doctor, pero hindi talaga like ‘pag di ka matalino, kailangan talaga yan hardwork tsaka patience

mo.

R: So, sa tingin niyo po, ano yung mga best aspects ng pagiging doctor?

Participant: Yung pinaka-fulfilling is yung magt-thanks sa’yo yung patient kasi natulungan mo

sila, and napagaling mo sila, tapos yung napa-uwi mo sila, kasi magaling na sila… ayun yung

pinaka-best aspect…

R: Uhmm. ano naman po yung most difficult aspects po sa trabaho niyo?

Participant: Yung katulad nung patient kagabi, public hospital kasi ako nagdduty, so ang daming

pumupunta sa amin. Maraming hindi nakakapag-afford, hindi din nakakatulong na malaki

gagamiting pera sa healthcare kasi lahat, halos lahat galling sa sarili nilang mga bulsa. Tapos isa

ring aspect na negative sa healthcare profession is yung, syempre, may mga patients tayo dito,

pagka may namamatayan. Like, marami nakong naging patients na namatay sa clear ko, bata,

matanda, babae dito, lalaki dito. Tapos pagka sunud-sunod siya, syempre, hindi mo nakokontrol

yung emotions, pero syempre we learn from all our teachings naman, so pagka may ganung

nangyayari, yun… ahh... try to learn from your patients and from your co-doctors…

R: Bale, nasagot niyo po doon sa survey na 11-20 na po yung na-experience niyong patient death

po diba? (pauses) tama po ba?

Participant: oo, mga ganung range.

R2: Mga ilan po ba weekly yun ganun? Sa tingin niyo po?

Participant: Well, siguro hindi naman weekly, like siguro in a month maybe 1 or 2. Kasi last year

nung clerk pa ako syempre may mga deaths na rin, although mas konti kasi private hospital kami.

Ngayon, sa public na hospital siyempre mas marami, so ayun nga kaya umabot ng ganoong range.

R2: Meron po ba kayo na parang significant na patient death na ayun po, na parang ayun po yung

maaalala niyo talaga?

Participant: hmmm. Ah iyun nung sa du-duty ako sa pedia, isa dun bata yung namatay. Based sa

recommendation ng CHR, meron siyang pneumonia, may classifications kasi ‘to, so yung class,

yung mga class niya kailangan talagang i-admit, so, pero wala kaming space, so in-advise namin

sila pumunta sa PJMP ,then ka hit papano, o bumalik sila sa PGH, ayun nga walang oxygen tank,

so bumalik sila samin. Tapos, parang in-admit na rin namin sila, kahit konti comfy [sic] lang, pero

hindi talaga siya comfy [sic] dapat sa ICU kaso nga lang wala talagang space. So, habang nandun

siya nagde-deteriorate siya, tapos na-intubate na siya, and then sa ER, sa ward, na undertook din

siya, ilang weeks din siyang naka-ospital. Tapos nagdeteriorate pa siya lalo,tapos napunta siya sa

ICU, yun ako yung in-charge sa kanya nun. So akalain mo sa dami ng doctors ako ulit and then,

halos 1 month din siya nasa hospital. March 30, 2004, nung nag-switch ako rotation sa surgery,

ayun, nakita ko nalang namatay na siya. (gasps) So yun, medyo weird kasi ako yung unang

nakakita sa kanya, tapos, until the end, iyun. Noong time na yon, nafeel ko na parang kasalanan

ko na namatay yung child…tinanong ko sarili ko kung baket… kasi a kala ko gagaling

siya….(inaudible)

R: So, halos bata po na yung mga patient na na-encounter niyong ganoon no po?

Participant: Oo, marami rin kasi actually hindi lang siya eh, child mortality din. Pero mayroon din

yung time ko noong duty ko sa ER. (inaudible 8:38-9:00) Pero ayun, wala naman siyang ginawang

masama. (inaudible 9:05-19) Na parang hindi na siya ma-ooperahan. (inaudible 9:23-9:40) Na

hindi niya man lang nakita yung anak niya. (9: 46-9:55)

R: So, during these encounters po, ano po yung parang na-feel niyo po kunyari after you, after

you’re informed na, ayun nga po na, your patient passed away na. Ano po yung naramdaman

niyo?

Participant: Like, syempre di mo inaasahang mangyayari iyon, (inaudible 10:16-40) Dati kung

anak siya ng someone, mga ganoon….((inaudible 10:43-11:11)

R: Sa tingin niyo p, iyon nga po, ano pong ginagawa niyo after this kunyari, kahit naman po

professional kayo dapat sa harap nila, syempre po, naka-feel pa rin po ba kayo na prang grief

towards them?

Participant: Oo, syempre. Pero hindi ko na hinahayang mangyari ulit. Kailangan din ng support

nila. (inaudible 11:44-51) Kapag na sa work situation ka, kailangan mong makita yung mga

problema. (inaudible 11:53-12:03) Naglalaan din ako ng time to cope up. I-assess ko kung ano

yung nangyari (inaudible 12:05-12:33)

R: Hello? Sorry po medyo nag-aano po kasi yung, nawawalan po ng signal yata. Hello? Hello?

Ayun po. Kunyari po, with your exp- kahit yung isang encounter lang po with patient deaths. On

average po, sa tingin niyo po, gaano katagal po kayo nag-grief doon sa patient na iyon?

Participant: Matagal din. Siguro yung ikwinento is nangyari 4 months ago. Hindi siguro average

pero magstay siya siguro 1 month. Pero I try not to think of it as much.

R: In what way po ba kayo parang na-affect, naapektuhan emotionally with these kinds of

experiences?

Participant: Nakakaapekto siya in a way na parang napapaisip ako na parang worth pa ba yung

pinagtrabahuhan ko. Parang enough na ba iyon. Ganoon lang din yung nangyari. Parang

mapapaisip ka na gusto mom aging doctor ganito lang din naman pala mangyayari. Lalo na kung

high stress yung environment tapos ganito yung mangyayari. Totoo na alam kong beyond my

control din naman na yung (inaudible 14:12-14:20 ) Pero ayun nga nakaka-affect siya sa akin

emotionally.

R: Sa parang work niyo naman po na, naaapektuhan din po ba yung performance niyo?

Participant: Well initially, siguro mga 1 or 2 hours matapos mangyari iyong death na yon. Pero

thinking nga na kailangan mo pa ring magtrabaho, tuloy-tuloy ka pa rin. Medyo traumatizing din

lalo na kung kunyari kung magfa-flatline siya ganoon. Kailangan mo siyang (inaudible), i-CPR

mo siya. Shift-shift kayo ng kasama mong intern. Parang nakakapagod din siya. Mahirap

physically and emotionally din. Pero ayun, tuloy-tuloy lang dapat talaga yung work.

Nakakalungkot nga na Makita yung kamag-anak doon sa gilid, umiiyak. So ayun kapag nagflatline

na yung patient, dapat balik trabaho lang ulit. Pero ayun, sabihin din sa relative na nagawa naming

lahat ng kaya namin, mga ganoon, kasi syempre tao pa rin naman yung hawak namin. Hindi lang

naman siya patient. Kailangan mong ipakita na may pakialam ka sa kanila. Parang treat their

relative as a ka relative mo rin sila kasi hindi naman sila like porket mahirap ganoon. Dapat

sensitive ka pa rin sa kanila. Hindi siya nakikita sa libro, ibang level ng dedication na tinuturo sa

iyo na makibagay sa patient. Parang show them sensitivity ganoon and compassion talaga. Hindi

lang enough yung alam mo yung mga ganitong bagay. Iba rin yung emotional intelligence na ina-

apply mo sa ganitong working environment.

R: Has your motivation din po ba to go to work been affected?

Participant: …Oo actually. Lalo na noong tertiary tapos ER yung shift ko. Parang I come to work

na, ano na naman kaya mangyayari today? Parang noong December, duty pa ako noon nung

bagong taon, syempre nakakatakot. May mamamatay ba today? Gaano kaya karami yung papasok,

yung mga danger accidents? Pero ayun, since part talaga siya ng trabaho namin, kailangan naming

siyang gawin. Kailangan mo talaga siyang tanggapin. (inaudible 17:18-17:24) Pero ayun nga

naging less yung motivation ko na parang ayoko na. Super nakakapagod na. Pero ok lang naman.

Within a day, marami rin naman akong natulungan. May nai-save din naman ako kahit papaano.

R: Yung relationship niyo naman po with other patients, like with the way how you treat other

patients after these experiences, this bad experience. Paano din naapektuhan yung ano niyo, yung

parang susunod niyong trabaho with other patients.

Participant: Mas naging vigilant ako kunyari sa mga critical care patients. (inaudible 18:03-18:23

) Syempre kapag alam mong critical, marerecord iyon sa kanila. Pagdating sa mga ganoon bagay,

kailangan maging vigilant talaga. Talagang mas strict kami sa kanila. Dapat din alert. Kailangan

ng alertness kapag naghahandle ng mga patients na ganoon. So kailangan mas prepared ka na next

time kasi alam mo na yung hitsura ng patient na may kailangan ng ganoong, anong kailangan

gawin, anong kailngan turukan. And inform their relatives, para at least maka-respond agad. Saan

ba naming siya ilalagay sa ER or sa ward. Yung mga ganoon talagang patients, kailangang mas

tutok kami and prepared sa kahit anong mangyari.

R: Pagdating naman po kasi sa susunod pong part nung survey noon, you actually scored high po

in your self-compassion. Sa tingin niy po, parang ano po yung importance ng pagiging self-

compassionate sa, as a medical professional po?

Participant: Para sakin, kung saan ako grumaduate, iyon talaga yung pinaka-cornerstone sa amin

when treating your patients. Kasi not everyone is mayaman, may kaya, para maintindihan kung

saan sila nanggagaling. Tapos naiintindihan mo kung ano yung nararamdaman nila. Kung

masungit sila, iintindihin na lang namin bakit sila ganoon. Kaya kailangan talaga maging

compassionate kasi, kunyari, kapag mabait yung hospital provider, parang mabait sila sakin,

naiintindihan ka nila. Parang mas nakakabuti iyon sa nararamdaman mo. Kasi kunyari pag

nagiging hostile yung mga ano, masungit ganoon, tapos ikaw may paki ka, paran mas nakakadadag

din yon sa nararamdaman mo. I just think it’s like, it goes both ways, so kapag mas mabait ka dun

sa patient, mas nakakatulong ka pa sa kanila kasi mas friendly ka, mas approachable. In a way nga

mas nakakatulong ka if approachable ka, mas caring. Mas napapadlai yung kanilang hospital stay.

Kasi nga yung mga kumakausap sa kanila, mayroon kang binibigay na trust. Iyon yung kailangan

mo talaga as a doctor.

R: Do you think din po ba yung pagiging mindful sa sa sarili niyong emotions is important as a

medical professional?

Participant: Oo, actually. Lalo na kapag kunyari night shift. Dapat mindful ka pa rin sa emotions

mo kahit stress ka na. Kasi minsan, nakaka-observe din ako ng ibang mga seniors na nagdo-doubt

na, minsan sa amin. So syempre hindi maganda. Pero as much as possible talaga dapat keep it in

check. Ok magiging masungit na ba ako medyo masama daw yung pag-ano ko sa iba. Iyon lang

talaga keep your emotions in check kasi parte ng pagiging professional talaga. Mahirap siyang

gawin pero kailangan siyang i-maintain.

R: Pagdating naman po sa ano, yon nga po, since you’ve encountered a lot of patient deaths, how

much these experiences made sense to you? Parang ano po yung naging meaning nila para sa inyo?

Participant: Yung meaning niya para sa akin…life is short talaga. Kahit ano pwedeng mangyari.

Pero from a doctor’s perspective, every patient’s death is a learning experience for us. Ano pa ba.

Learning experience siya talaga. Tapos pati yung emotions kasama doon. Doon ko na-realize na

kaya ko pa lang maka-experience ng grief towards someone na hindi ko kakilala.

R: Pero ayun po, despite your loss, and despite of treating this kind of experience as something na

makakapag-improve po sa inyo, ano pa po yung ibang benefit po na sa tingin niyo na nahanap,

nakita niyo po through these experiences of loss?

Participant: Parang mas nagiging attentive ka towards better health care qualities, policies. Minsan

yung mga patients, kulang sila sa pera, ganoon, kulang sila sa attention na nabibigay ng hospital.

Syempre hindi lang naman iyon yung ultimate cause. They’re part of a bigger system na kailangan

talagang gamitin. So as early as now, syempre napapa-isip din ako na may kailangan talagang

baguhin sa systema. Kasi mostly talaga yung mga patient deaths, hindi talaga nakakakita ng doctor

on time, walang pera panggamot mga ganoon. So pushing better health care policies for everyone.

Sana mas matutukan siya ng government na universal yung health care or mas provided siya ng

government na hindi na talaga gagastos yung patient. Usually kasi hindi, hindi naman lahat

nakakapagbayad. (inaudible 2:54-2:52)

R: With the way how you find meaning po in handling patient deaths, sa tingin niyo po, ano po

yung role talaga ng ganitong ability?

Participant: Sorry sorry ano ulit yung tanong?

R: With the way niyo po na sinabi, kasi po kanina diba parang, yun nga po na may sense yung

pagkakaroon ng experience ng patient deaths, sa tingin niyo po, ano po yung role ng pagbibigay

ng ano, pagbibigay ng meaning towards these experiences. Ano pong role sa inyo personally and

professionally?

Participant: Siguro yung accepting na rin what’s our job. Kasi doctor ka, nakikipag-deal ka sa mga

tao. Pero tatanggapin mo na rin yung craft, yung role, mayroon talagang hindi gagaling. May iba

talaga na namamatay din. So yung role din talaga ng acceptance, yung mga ganoong situations.

Tapos ayun nga, learning experience talaga siya kasi kailangan mong i-accept yung death as part

of life in any age ganoon bata man or matanda, parang kahit ano kasi talaga pwede mangyari. Yung

iba hindi mo akalain na gagaling siya, yung iba akala mo wala ng pag-asa, yung iba pauwi na nga

lang, bigla na lang din palang mamamatay. Anything that can happen, unexpected din. So kahit

unexpected pa siya, i-aaccept mo na lang din. Kasi syempre lahat naman ginawa mo (inaudible

28:05-28:16)…na you did your best. Kasi eventually kung hindi kaya ng katawan nila ganoon,

parang late na rin siya. Kahit naman sila hindi na-accept yung ganoong unexpected, kaya tutulong

mo na rin sila doon.

R: Overall po, do you believe po na you have changed as a person since those experiences of

patient deaths?

Participant: Oo kasi naka-experience din naman ako ng death within the family. Tapos iba din siya

kapag nakikita mo na siya in a different perspective. Nakikita mo yung relative niyang nag-grieve

over someone na naging pasyente mo. So ayun, kakaibang siyang experience. In terms of if

nagchange ba ko as a person parang mas na-motivate pa kong magwork. Mag-aral pa ng mabuti.

Ano kayang prevention or management nila para hindi maulit yung nangyari. Ano ba yung naging

kulang ng hospital, ano ba yung naging kulang na gamit, gamot. Ano kaya yung pang better

improvement. (inaudible 29:47-56).

H9.

Participant 28 (33, Female, Metro Manila)

Medical Practitioner

Years in profession: 1 year

No. of Patient Deaths: 1-5

HGRC Score: 1.10 (Low)

SCS-SF Score: 2.75

GMRI Score: 3.33

R: Can you tell me a little bit of yourself po before we start in to specific research questions like

name, sa work po ganyan.

Participant: My name is [redacted]. I’m a medical doctor, graduated at 2016 in Emilio Aguinaldo

College of Medicine and I took my internship at Jose Reyes last 2017. I took the boards the first

time but unfortunately failed. But I took it again on the second time this last March 2018 and

passed it. Now, I’m working at a Diagnostic in somewhere in Malate as a assistant medical director

R: Kaka-take niyo lang po this September right? This September po ba?

Participant: No, last year, March.

R: Congrats po.

Participant: March 2018. Thank you.

R: Pero kailan po kayo nagstart talaga as…dito sa profession? Ano pong year?

Participant: Nagstart ako ditong student sa medicine? Actually nagstart ako noong 2008 pa. Tagal

no? 10 years in the making. 2008, yon nga lang, kaso kasi yung barkada, dami kasing barkada

noon. Hindi naman talaga ako ganoon ka-focus talaga sa studies ko. So umulit ako ng 2nd year and

3rd year. 3rd year yon lang minalas ako, na-kick-out ako sa school. Yung first school ko is San

Beda. Tapos noon, nagstop ako para magpahinga. After 1 year, tinanong ako ng nanay ko na kung

gusto ko pang ituloy. Nag-ok sige, try ko lang ulit if ever. Noong lumipat ako ng school, syempre

bagong curriculum, nagsimula ka na naman, may 2 subjects akong nabagsak ulit. So inulit ko na

naman siya, yung 3rd year ko. Sa bale parang 3 beses ko inulit yung 3rd year ko. And then after

noon, dire-diretso na. Nagtake-off na siya yung career.

R: How do you see yourself po ba as a doctor?

Participant: How do I see myself as a doctor? Mas nakikita ko yung sarili ko sa community.

R: Ano po yung mga goals niyo as a doctor?

Participant: …Mas nakikita ko yung sarili ko sa community. Mas nagfocus sa mga health

preventions, sa pagtulong sa mga lesser…

R: Privileged?

Participant: Less fortunate na mga tao. Yung mga hindi makapunta sa hospital, mga hindi kayang

magpagamot kasi walang-wala talaga sila. Siguro in the near future, hindi naman ako magtatagal

dito sa mga part-time na ano lang…

R: Ano namna po yung nakikita niyong best aspects sa pagiging doctor?

Participant: Best aspects ko?

R: Best aspects po ng pagiging doctor niyo.

Participant: Yung pagiging doctor?...ok parang wala ako nun.

R: Hindi po yung kunyari po---

Participant: Siguro yung pagiging pursigido.

R: Ayun po. Opo. Yung kunyari po, bilang doctor po ano po yung parang kinaganda nun? Ano po

sa tingin niyo, yon nga po yung maganda na doctor? Parang ano po yung worth ninyo ganoon.

Participant: As a doctor? Kung ano yung maganda? Wala, actually. Hindi, ang doctor kasi dito sa

Pilipinas parang ano lang. Sa tingin ko lang, parang ordinaryo lang. Hindi siya katulad ng mga,

kumpara sa pag lawyer ka, pag politician ganoon. Sa nakikita ko sa Pilipinas, iba yung treatment

ng mga tao pag doctor parang ordinaryo lang, minsan kapantay lang yung tingin nila sa doctor

dito. Ano pa ba? Siguro, sa ibang tao kasi tinitignan nila sa edad para lang masabi na ito M na to,

experienced na to, matagal na tong doctor kaya mas bibigyan nilang respeto. Hindi pantay sa lahat

ng doctor yung binibigay na treatment.

R: Ano naman po yung mahirap na lagay ng pagiging doctor?

Participant: Mahirap na lagay ng pagiging doctor?

R: Opo, Like sa experiences niyo din po ganyan.

Participant: Siguro yung…Wala akong maisip teka lang…For example, ito nga yung health system

natin, alam mo naman yung systema natin dito sa Pilipinas diba, hindi ganoon talaga

pinaprayoridad yung health system dito sa Pilipinas. So ang tendency, yung karamihan ng

ano…siguro financially yung iba napupuna, nasasagad ng doctor. Parang yung burden ng

kakulangan ng hospital, ng health system, napupunta sa doctor. Kaya parang na…ano ba yung

term dito…Nababato, napupunta doon sa doctor…at saka yung pagiging full potential ng pagiging

doctor, since kulang-kulang nga dito, hindi 100% yung nabibigay sa patient. Isa yun sa problema

na mahihirap ng pagiging doctor dito.

R: Parang hindi niyo din po nakukuha yung tamang growth din as a doctor kasi ganito po yung

sitwasyon natin dito sa Pilipinas? Tama po ba?

Participant: Oo, isa pa yun. Alam mo hindi equal yung ano natin, in terms of financial, yung

income. Hindi equal. Yung part mo, over-worked ka, pero underpaid ka. Isa pa yon.

R: Pero ayun po sa survey sinagot niyo na naka-experience or naka-encounter po kayo ng at least

1 to 5 na patient deaths?

Participant: Oo

R: Parang monthly po ba, ilan po yung na-encounter niyo talaga?

Participant: Noong clerk ako, wait lang…Hindi ko na mabilang. Siguro 2. Mga ganoon, isa or

dalawa. Pero noong intern ako, mas…nakaka-tatlo a month. Kasi mas government na yung

napuntahan ko noong internship. Noong clerk ako private pa yung hospital na napuntahan ko. Itong

internship na to, public na so mas medyo maraming ganoon.

R: Mayroon po ba kayong naalalang specific na pasyente na namatay po under your care din po

noon?

Participant: Hindi under my care talaga--

R: Pero ayun po attending din po kayo sa kanya.

Participant: Parang isa ako doon sa kasama sa team. Mayroon. Yung isang—sabihin ko ba yung

story paano siya namatay?

R: Opo, describe niyo po paano yung nangyari.

Participant: Yung isang patient, actually stable na siya, sa IM ito. Stable na siya kaso ang nangyari

is gusto niya mag-CR. Tapos noong pagdating niya sa CR, bigla na lang siyang bumulagta, ayun.

Dinala naming syempre sa ano, nagresuscitate kami. Kaso wala, hindi na siya…namatay na siya.

R: Ano po yung condition niya?

Participant: Hindi na siya na-recover. Heart problem yata. Nagstroke siya tapos dinala siya sa ER

tapos yon nga na-recover naman, ok naman. Tapos yun, nagrequest siya na mag-CR siya. Ayun,

doon siya inabutan, bumulagta na lang.

R: Mga ilang weeks or months niyo po siyang hawak noon as your patient?

Participant: Hindi, wala pang day. Hours lang. Kasi sa ER lang siya.

R: Ok po.

Participant: Mayroon pang isa, sa pedia naman iyon. May 1 week kaming inaalagan na baby,

newborn siya. Kaso nagkaron siya ng complication sa baga. Kasi nakahalo ata siya sa meconium,

yung parang dumi nila sa loob ng tiyan. Ayun, 1 week kasi ako sa department na MICU, parang

IC ng mga newborn. 1 week kaming nag-aalaga sa kanya, then after ng isang duty ko, nakita ko

na lang na nilalabas na yung ano niya, kung saan siya naka-higa. Akala ko ililipat lang siya, yun

pala wala na, patay na din siya.

R: Ano po yung parang na-feel niyo sa experience niyo po na yon?

Participant: Actually parang…malungkot. Para sakin syempre malungkot kasi parang hindi mo

na-fulfill…parang feeling mo kulang yung ano mo…yung naibigay mong tulong, naibigay mong

alaga as a doctor. Malungkot pero hindi ko naman talaga siya dala buong araw o buong linggo.

Hindi naman.

R: Ano po yung ginawa niyo after? After nangyari po yun?

Participant: Balik lang sa duty.

R: Balik lang po sa duty? Hindi naman po kayo parang naiyak ganoon?

Participant: Natulala? Hindi, hindi naman. Parang ano kasi…isipin na lang yung ibang pasyente.

Namatay siya so huwag mo ng hayaan yung iba. Alagaan mo ng mas mabuti.

R: Hindi naman po talaga umabot ng 1 week something yung ano, yung pag-grieve niyo?

Participant: Hindi naman, wala naman. Siguro may day lang kasi sanay ka yung pasyente nandoon,

aalagaan mo. Tapos babalik ka, makikita mo wala na siya. And alam mo kung ano yung

kinahantungan niya, alam mong hindi siya nakauwi ng masaya, ng buhay. Iyon lang pero hindi

naman siya yung na-bother ako na pati yung trabaho ko naapektuhan. Hindi naman.

R: Naapektuhan din po ba yung emotional na ano niyo ganya? Yung emotions niyo, kung dati po,

mas naging sensitive po ba or ganoon from these experiences?

Participant: Siguro mas maingat lang. Mas naging…hindi naman istrikto yung term…ano tawag

doon…Ayun mas naging maingat lang ako sa hinahawakan ko. Mas naging segurista na talaga

yung tinitignan mo yung problema ng pasyente. Pero hindi mo kasi talaga maiiwasan yung mga

problema pagdating sa ganyan.

R: Sinabi niyo po kanina na hindi naman po masyadong naapektuhan yung motivation niyo to go

to work diba?

Participant: Oo

R: Yung confidence level niyo po as a doctor, naapektuhan din po ba?

Participant: Siguro may time na ganoon lalo na kung komplikado yung mga nakakasalamuha mong

mga pasyente. May times na kaya ko bai to? Pero syempre may papasok pa rin na, from that

experience na namatayan ka, may natutunan ka. Nalalaman mo kung ano yung mali mo, kung saan

kayo nagkamali. So hindi mo na siya uulitin. Malaking impact yung namatayan ka, yung learning

talaga yon. Kung saan ka dapat mas mag-iingat. Ano yung mga babantayan mo? Pero syempre

nandoon pa rin yung doubt na kaya ko ba yon. Kaya ko ba kasi parang iba yung sakit niya. Hindi

ka sigurado if ito ba yung sakit niya. Baka magkamali ka, mamatayan ka. Kaya madalas nirerefer

ko na lang sila sa mas, sa consultants, yung senior kung hindi ako sigurado sa naiisip kong sakit

nila. Yung management, hindi ako talaga sigurado sa management. Nirerefer ko sa senior.

R: Doon po kasi sa isang part ng survey namin is about self-compassion. Yung score niyo po kasi

doon mataas. Gusto ko pong itanong na, sa tingin niyo po ba yung pagiging mindful and caring sa

sarili, gaano po siya ka-important in being a doctor with all those patient deaths experiences?

Participant: Para sa akin, importante talaga na alagaan mo yung sarili mo kasi sinong mag-aalaga

sa iba kung ikaw mismo hindi masigla? Hindi mo mahal…parang andami mong problema sa

buhay. Maaapektuhan talaga. Para siyang domino effect. Kung may problema ka kasi as a doctor,

hindi mo maibibigay yung best mo doon, best diagnosis, best of mind doon sa pasyente. Baka

ubo’t sipon lang yan, hindi mo ma ano, mamamatay pa. Mauwi pa sa kung anong sakit. Kaya

importante talaga na yung doctor…yung doctor mismo mindful sa sarili niya na healthy siya sa

mind, body, spiritually.

R: Paano niyo po ba nababalance yung emotions niyo and your responsibilities being a doctor po,

particularly pag namamatayan ng pasyente.

Participant: Paano ko nababalance? Siguro sa dasal lang talaga. I mean, yon lang talaga

yung…pinaka-weapon ko siya everytime na magdu-duty ako lalo na pag pagod na ako…pag

napapagalitan, nasisigawan, malungkot, yon. Kapag namamatayan, parang ang worthless mong

doctor kapag namatayan ka. Ayun, dasal lang na bigyan ka pa ng courage, perseverance, strength.

R: Pagdating naman po sa pagbibigay ng meaning sa experiences niyo po na yon, sa tingin niyo

po nagkaron sila ng meaning sa buhay niyo?

Participant: Oo naman, hindi naman ako magiging doctor kung wala yung mga taong yon. Sila

yung best teacher ko at naging doctor ako. Hindi naman yung mga libro yung 100% mo, yung mga

pasyente, yung mga experiences mo na yon na bahagi sa pagiging doctor mo.

R: Despite po yung mga loss niyo na yun, sa tingin niyo po, ano pa po yung mga…ano naman po

yung naging benefit ng mga pangyayaring iyon sa inyo?

Participant: Well yun nga yung sinabi ko, mas naging maingat, mas naging…anong tawag

dito…yung parang…mas ma-scrutinize…mas matanong, binubusisi. Mas mabusisi ka na doon sa

pasyente. Parang ayaw mo na siyang…ayaw mong may malagpasan ka na importante.

R: Mas careful po ganoon?

Participant: Ayun, mas maingat.

R: Overall po naniniwala naman po ba kayo na nagbago kayo as a person from those experiences?

Participant: Na sa survey ba yan? Kasi parang wala…

R: Na sa survey po siya about…since nagkakaroon po siya ng meaning sa inyo yung experiences

na ganoon, sa tingin niyo po, nagbago po kayo doon? Yung outlook niyo po sa buhay, yung values.

Participant: Parang wala naman. Parang hindi ganoon ka-ano sa akin. Parang wala siya talagang

effect sa akin. Based sa work, oo. Pero yung sa buhya ko talaga, wala…life goes on, ganoon talaga

ang buhay, may namamatay. Pero as a doctor, mas ano ako…Sa career ko, oo. Ayun nga mas

naging maingat, naging segurista. Pero bilang ako, bilang tao, parang wala lang. Kung oras niyo

na talaga. Ako may oras din ako na darating. Pero hindi siya yung parang ano sa akin malaking

impact na ok namatay siya, malulungkot ko. Hindi naman. Wala naman siyang big impact sa buhay

ko.

H10.

Participant 19 (28, Female, Metro Manila)

Medical Practitioner (Internal Medicine)

Years in profession: 5 years

No. of Patient Deaths: > 20

HGRC Score: 1.63 (Ave)

SCS-SF Score: 2.92

GMRI Score: 3.28

Participant: Hello, good day!

R: Ayan uhmm ayan po start na po tayo.

Participant: Okay sure.

R: Before po pala tayo magstart, can you tell me a little bit about yourself po like name and

personal experiences, anything po. Anything under the sun.

Participant: Ahh wala naman masyado. I’m a second-year medical resident at a big tertiary

hospital and I don’t want to say kasi kung, ano tawag dito, kung saang hospital but then I’m a

resident at a tertiary hospital here in Manila tapos well wala naman ayun. I don’t think that

there’s interesting about me kasi most of my life is work and home lang naman.

R: hmm ahh ok po so resident na po kayo no? May anu na po ba kayo parang years po sa

residency?

Participant: Oo, I’m a second-year resident, I’ve been to my junior internship and senior

internship as well as yung first year residency and ayun, currently my second year. And, before I

made it to med school, I was a nurse. So again, ayan I had experience narin in hospital.

R: hmmm. Pero ngayon po, ahhh, how do you see yourself po ba as a doctor?

Participant: Ah wait , well, paanong how do you see yourself? Parang work?

Participant: Ahh goals, so well, my goal could be where I see myself in life as a doctor,

sometime in the future siguro, like yung ginagawa ko everyday, like trying to make a difference

with your patients parin, parang ahhh part na talaga yon parang hindi na talaga siya goal parang

it’s my job being in a different life hindi naman siya parang, yun talaga yung trabaho ko e, in a

way kunwari ang teacher is ang ano niyo is magturo to help individuals to be successful in life,

ako naman it’s my job to do what I can with my patients parang yun na talaga hindi lang para sa

patients but in terms of personal, ayun lang naman, personal growth

R: So, can I ask what do you think po are the best aspects of being a doctor?

Participant: Well, kase, uhmm, you get to save them. Eventually, yung mga tao na uhm even

from people who come in due to cough and cold lang ubo sipon, you make a difference, yung

mga nagtatae, from people who are needing more care like nag-aagaw buhay so from small to

big, talagang everyday may ginagawa kang difference eh and then tapos yung mga resident, ikaw

yung sa, dun sa hospital, so your job to see a patient and to foresee, ibig sabihin uhm you have to

address the current problem of the patient and if you also have to think na ano kayang pwedeng

maging problema nito and you have to think two steps ahead if want to avoid more

complications. So, it’s very rewarding if you do your job well, so ganun, parang, uhm, you save,

you address the problem and then you prevent them from having complications and then when

you get to send them home, that’s very fulfilling. And you’re thinking, or they’re saying “Thank

you doc”, even relative na nagsasaabi sayo na “Thank you for saving the life of my mom”

merong mga ganun. Tapos very, it’s very rewarding.

R: Mhmmmm. Ano naman po yung sa tingin niyo na parang most difficult aspects po of being a

doctor?

Participant: Honestly, nakakapagod. I go on duty. A normal person goes to work, 8-5. So they

come in at 8 and go home at 5. So being a doctor, in my own coverage, I come in at 7 when I am

on duty, then I go home mga 5am the next day. Pero yun yung normal ko. And then the

following day, I have to come in at 7 in the morning hanggang 5pm the same day. And I have to

work every ano… just like that for the whole year. I don’t get off. Wala akong, di kasama yung

holidays, So eventually burned out ka. And parang makikita mo how can you function 36 hours

straight and then tuloy-tuloy lang talaga. So yun, nakaka pagod and very demanding kasi yung

work kailangan all the time parang alert ka kailangan gising ka kase your work is at stake you

dont have mga room for errors di pwede “ay oops nagkamali ako sorry ulitin nalang natin” diba

like that so ayun, anong tawag dito, yung yung pinakamahirap kase with pressure at the same

time demanding yung job, pagod ka, tapos you have to deal with your bosses, yung mga

consultants mo, and people have to work with you, siyempre sasabihin yung expectations sayo

kase alam nilang doctor ka and then they are expecting you to perform na mas magaling so it’s a

very demanding job, nakakapagod yung schedule mo, hindi pang tao, and then, ayun, pero, that’s

the hardest part and eto pa, it’s not like or a normal kunwari if uhm nag BS Psychology ako uhm

marami akong options kasi kapag BS Psych ka you can go into medicine, you can go teaching,

you can go like parang sa counselor, ang daming or you can go HR so parang ang dami mong

options and pero ikaw nag doctor ka wala kang, eh kasi nag aral ka for 8, 10 years and then after

non ano pang mga options mo na job? Pero siyempre pwede ka ding magturo. Another thing is

you can go into business. So parang, yung mga jobs na pwedeng gawing alternatives mo like

hindi ka naman pwede yung basta basta nalang na “Ay ayoko pala mag - doctor” after all these

years parang ganun although that happens din naman so yun nga parang ang tagal mong nag-aral

so parang there’s parang di ka na wala ka ng room na parang “ay mag-aral nalang ako ulit ng

another thing” iniisip ko na mag ano nalang ako mag math or mag engineering hindi ganun hindi

katulad ng four-year course na pwede magsimula ulit. You get the point?

R: Opo.

Participant: So parang wala kaming ibang alam gawin. I’m sorry. Sa pagiging doctor, wala

kaming ibang options. Bukod sa pag dodoctor pero yun.

R: Ahh opo. Parang nagkaroon po, parang mas focus po kasi dito sa field na to?

Participant: Oo. Sobrang specialized na kasi ng field na pinasukan so ganun.

R: Ummm. Ayun po, uhmmm, dun po sa survey nasagot niyo po na like 1-5 na po yung patient

death na naexperience niyo? Tama po ba?

Participant: 1-5? Woah. More.

R: More po pagdating sa ano, like under your care na po talaga sila?

Participant: Well, everyone kase ano, kunwari ako, I’m assigned when I was a first year, I was

assigned a ward, so yung ward na yon it has 30 patients, and then isipin mo nalang yung ratio

niyan is 30 patients per day times 365. Tapos yung number of patients na nahahawakan ko in a

year. So ganun, statistically, I will experience more or less, death talaga. And then I think in my

whole career, I think more than 20 na yung nakita kong namatay.

R: Averagely, ano, ilang po yung parang na-encounter niyo ganun kahit every month? ganun po?

Participant: Siguro, atleast once a month meron.

R: Meron po ba kayong pang uhhh certain patient na naalala niyo po na ayun namatay po under

your care?

Participant: Siguro uhmmm, I had a patient na 4 month under my care. She was my patient for 4

months. Siyempre, she was a cancer patient, so like expected naman na mamatay din talaga siya.

Pero again dahil 4 months ko siyang naging pasyente, eveytime I change ward, andun siya sa

ward ko. So we got attached, and then, especially if the patient is very nice, and bata pa so

parang sayang yung buhay and despite eveything that youve doneand parang binigay mo yung

eveything yung maximum na pwede mong ibigay and kung ano man yung technology na meron

ka and yung hospital despite it all you ccan’t fight yung illness niya so parang it would feel na

parang sana may nagawa ka pa pero alam mo naman wala na pero dahil mabait yung tao parang

masakit pa din ayun kahit expected mong ayun mamamatay siya dahil you believe you have

grown attached to the person masakit padin na parang namatay pero in the end parang wala

ganun talaga e the cycle of life eh di mo kayang pigilan na kahit anong gawin mo talagang di

talaga di talaga ano yun di mo kayang labanan yung sakit na

R: Nung po bang time na yon can you parang describe po kung paano po kayo, paano niyo po

siya inaabsorb, parang, ano po yung nafeel niyo dun sa experience na yon?

Participant: Well syempre I felt being sad uhhh talagang umiyak ako kase nakakalungkot and

then siyempre anong tawag inging dito seeing yung parents and relatives pa nung patients adds

to the parang pain nung nangyayari so uhm hind as a doctor hindi mo dapat ipakita sakanila na

affected ka so at that time nung parang iiyak nako parang I had to excuse myself from the family

and then iiyak nalang sa restroom ayun umiyak ako sa restroom and then after that ayun wala e

you have to go to work din after so parang ayun just have to ensure na it’s all from the past either

parang wala ka ng magagawa give yourself a moment to greive and then you have to face your

patients pa na buhay pa na kailangan mong talagang, sila naman eh ganun na man talaga e, it

wont stop, the world wont stop your job wont stop

R: Mhhhm. Gaano po katagal niyo, sa tingin niyo, na naramdaman yung lungkot na yun?

Participant: Well, hanggang ngayon naman if you think of it parang ako, siguro ako kung iiisipin

ko parin yun uhm parang when I look back siguro merong konting sadness pero hindi naman

ganun kabigat na like the first time so I think uhm ganun anong tawag dito yung grief naman

depende kasi yan sa kung paano mo kung paano yung outlook mo like parang uhh it’s a feeling

e, yung feeling na yan mararamdaman mo talaga, you have to deal with it talaga, so yung like

pag deal ng grief siguro it depends on the person so for me personally uhmm is that you

remember the times parang yung moments na sad and then yung moment na happy and then after

that that’s okay na wala na okay na ulit

R: Mhmmm. Opo. Since parang okay naman po yung pag take niyo sa grief paano po kayo

nagccopr with it po? Like meron po ba kayong mga like other activities na ginagawa?

Participant: Activities? Oh well, sa sobrang busy ng work ko we dont really have time to do

other stuff, so we just, just do your work e, ako ganun, sa trabaho, trabaho din ganun, parang

nasanay na kasi ako na talagang uhmmm paano ba kasi nga diba I have encountered a lot of

deaths ng mga patients so anong tawag dito uhm kumbaga hindi na siya hindi na siya ganun

kabigat unlike nung when I was starting na parang yung work mo has been really hard , parang

ano na talaga e, parang uhmm nag sink in na sakin na you wont save everyone, you can’t save

everyone so you just have to move on so wala naman special uhm way to deal with it, siguro you

just talk to people about it, yun yung pinaka helpful, you talk to the nurses, kasi yung mga

pasyente ko, pasyente din nila uhmm you just remember them like “oh naalala mo ba si ganitong

patient” ganyan “oo nga” yung mga ganun? Yung mga random lang na pag-uusap siguro yun na

yun that’s the most of it na ginagawa ko well I talk to people about it who knows the person ah

hindi naman yung hini kilala yung tao yung mga ganun lang.

R: Sa tingin niyo po, how did this loss of a patient affect you professionally po?

Participant: I think, yung nga, yung sinabi ko before na, anong tawag dito, uhmm being able to

learn na hindi ka diyos, you learn na you can’t save everyone and then siguro okay naman kase

personally parang wala naman walang specific na ano e parang a patient’s death parang di nman

talaga siya parang life altering well anong tawag dito hindi in a way na for me uhm for me

everyone is the same naman na lahat yan pasyente lahat yan ginagawa ko yung best for them

pero pag di nagawa yung, parang namatay padin and then there are things that are out of my

control siguro yun lang talaga I learned na kahit anong gawin mo kahit anong gusto mo wala e

R: Naapektuhan po ba yung parang motivation niyo to go to work because of this?

Participant: ahhh I don’t think so naman yung motivation ko naman to go to work is to save the

people uhm not because of a particular person

R: How about your confidence po as a doctor?

Participant: Uhm, I dont think so. Kase uhm, usually naman pag namatay naman yung patient

siguro ang maiisip mo lang na sana parang mas nakita mo yung patient na to ng mas maaga

parang san he came in earlier para I could have done more kasi ganun naman usually yun e

parang in the cases of the cancer patients so parang you have no choice naman kasi you see

cancer patients na stage 3 stage 4 so pag ganun terminal na so yun lang parang ahh sana nakita

ko nalang ng mas maaga tapos again from the job pag ganun na talaga sila dumating you know

na in yourself na kahit anong gawin mo kahit anong tnatry mo pwede parin talga e andun parin

sila sa possibility na mamamtay sila and yun

R: Uhmm, bali dun sa isang part po ng survey namin uhh is about self-compassion and dun sa

part po na yon you actually scored hign po and ayun sa, gusto ko lang po malaman yung

thoughts niyo about important na mindful ka sa emotions niyo pagdating, ay, mindful po kayo sa

emotions niyo regardless these experiences po?

Participant: Oo yun nga as I were saying earlier, anong tawag dito, uhm sa profession ko, sa

pagiging doctor, hindi ka pwedeng affected and yung if affected ka man you dont have, you

shouldnt show, di ka dapat nagpapakita sa mga pasyente mo na naaapektuhan ka you try to learn

your emotions kase uhm itong patient na to, again I handle 30 patients, kung mamatayan ako ng

isa, yung the remaing 29 of mypatients still needs me so if a patient, if another patient sees me na

umiiyak and then they will be bothered ano parang hindi sila pwedeng mabother kase youre

trying to have them get better if they see you na ganun siyempre parang as a patient parang

maffeel din nila yung emotions mo e kasi ikaw yung ka-interact nila so when they see you na

you’re not that well syempre yung confidence lang nila din if may nangyari ba sakin yung ganon

parang the patient would think that the thing was wrong is them hindi ako parang ganun and then

anong tawag dito kunwari iba iba yung mga problems iba iba yung pinagdadaanan so as time

goes by parang naiintindihan mo na sila you learn to adapt kung ano yung kailangan nilang

maging ikaw yun yung pinapakita mo sakanila if you feel that your patient needs a strong doctor

if the patient needs more of your support maybe that would be the type of doctor you should be

that time mas matagal mo siyang kausap ayon so parang base on my experience youre uhm

parang kumbaga parang mararamdaman mo na kung sino sa mga pasyente mo kung ano yung

mas kailangan nila parang ganun

R: pagdating naman po sa ano, ayun nga oo naka encounter na kayo ng madaming uhh

experience po na patient death, sa tingin niyo po parang how did these experiences made sense to

you?

Participant: Uhhh how did it make sense to me? Well…

R: parang did they make certain meanings po sa values niyo, sa life niyo po, personally?

Participant: Ahhh siguro, how short life is? How important spending time with your loved ones

more or kumbaga how fragile life indeed siguro yon yeah you learn to value every moment of

now yung lang

R: Parang ano, despite your loss po ba have you been able to find benefit from these

experiences?

Participant: I think yes. Meron naman. Siyempre everyday siya. Whether they live opr they die.

They provide me of clinical ano eh clinical insights clinical judgement so yun I also learn by

them parang tinuturuan din ako ng mga pasyente ko kung paano yung sakit nila kase kahit silang

nagddiarrhea not all of them would feel the same hindi lahat parang di sila like what do you call

it parang iba ibang tao, kahit isa lang yung sakit niyan, magkakaiba yan ng nararamdaman so

parang ganun din sa mga patients so like parang depende yan sa sakit so parang like pneumonia

example lang lang like I have more than 20 of them tapos yung pagkakamatay nila is due to

different factor so uhhm anong tawag dito each of them taught me something kahit pare parehas

lang yung sakit

R: Sa tingin niyo po ba as a doctor malaki po yung role sa pagbibigay ng meaning sa mga

experiences na ito?

Participant: Pagbibigay ng ano I’m sorry ano yon?

R: Meaning.

Participant: Oo naman we are all in charge of everything we experience so if you see it then good

if you dont well it’s another experience that lam mo yon nandito ka

R: Do you believe naman po na you have changed as person since those experiences po of

patient death?

Participant: Oo ah. Yes definitely kase nga as I said to you yung first death would be the hardest

yun yung pinkamalaking ano e yun din din yung pinakamalaking pag iisip na ano ba yung dapat

kong ginawa ano ba yung di ko nagawa bakit namatay to may gnawa ba akong mali may dapat

ba akong ginawa na hindi ko nagawa may dapat ba akong anong tawag don may dapat ba akong

nakita na hindi ko nakita yon pero along narealize mo na kahot gaano ka kagaling may mga

bagay na out of your control eh.

H11.

Participant 37 (28, Male, Metro Manila)

Medical Practitioner

Years in profession: 2 years

No. of Patient Deaths: 1-5

HGRC Score: 2.80 (High)

SCS-SF Score: 3.33

GMRI Score: 2.78

R: Can you tell me a little bit about yourself po? Like name, name muna po and ayun mga, kung

may gusto po kayong update about sa inyo po, personal.

Participant: I’m JM [redacted], 28 years old. Recently passed the board exams. And I guess just

like any other medical student lang din who, I just want to have a life outside the hospital also.

Kasi hospital work and the things you do din…it really takes a toll on you. So you would really

want a life outside the hospital. My outlets outside hospital work is arts, photography…it keeps

me grounded on who I am as a person.

R: Interesting po. And congrats din po sa pagpass sa board exams.

Participant: Thank you.

R: Kailan lang po yon? Nung October tama po ba? Kailan kasi yung last?

Participant: Yeah, September 2018.

R: Nagwowork na rin po kayo noon?

Participant: Yes, I’ve had a lot of hospital work and exposure kasi years before the board exam as

a requirement. So, exposed talaga kami sa hospital setting and with patients.

R: Yung area of practice niyo po is general practice lang po…pa lang po no?

Participant: Yes, general practice.

R: Do you have plans po for specialization?

Participant: Yes, I’m planning to take-up ophthalmology this coming year pag nag-open na sila.

R: Ohh, next question po, how do you see yourself as a doctor?

Participant: I guess, actually that’s a difficult question. Sa pagiging doctor? How do I see myself

as a doctor?

R: Yes po, opo.

Participant: I think, as a doctor, I’m someone who’s got a lot to learn, still. And I know I still have

a long way to go. And I’m someone who’s thirsty for knowledge. And I’m not really afraid to ask

questions. So, I guess I’m more of an inquisitive type of person. But I tend to doubt myself

sometimes with my decisions. I guess it’s one of my fear, minsan natatakot ako with regards to

decision-making. So I tend to really ask help from others especially if I’m really having a difficult

time, not only with medical decisions but general things in life.

R: Within your 2-year experience po as a doctor now, what do you think are the best aspects of

being a doctor or being a medical professional po?

Participant: One of the best aspects with a medical profession is getting to see your patients

improve from their initial condition and you see that they’re improving in more aspects than one

management you gave them. So it’s really in the follow-up that you see the fruits of…yung

hardwork talaga, yung pinaghirapan mo, yung naging usap-usapan niyo ng patient niyo. And then

knowing na nagtitiwala sa iyo yung patient mo, and that they can even recognize you outside of

the hospital. And they get to tell other people about you, about what you’re doing, about the

difference you’re making in their lives. So, for me it’s really the general impact sa quality of life

na nabibigay mo sa person, not only on yourself pero in the other aspects sa life mo na…like they

can do things that they weren’t able to do because of their current condition. Nagyon mas maayos

na yung condition nila, nakakalakad na sila, nakakalabas na sila, nakakatravel na sila, they can

spend more time with their families. So, I guess it’s really the fulfillment of knowing that you were

able to improve their lives in your own way.

R: Ano naman po yung most difficult aspect of being a doctor or medical professional?

Participant: For me the most difficult aspect would be being away from your family, from your

loved ones. Kasi I don’t know if you know, but we doctors go on duty…2 days na may

duty…you’re really tired and most of the time you don’t really get to spend quality time with your

family tapos th next hospital ka na ulit. It feels monotonous kasi. So I guess that was one of the

most difficult things na…you’re time to the hospital, you’re time to your work. Sometimes, you

really have to prioritize the hospital and your patients instead of your family and friends. It’s really

a great sacrifice on your part being able to work in the hospital setting. So it’s really giving yourself

to others than yourself.

R: Regarding naman po sa patient deaths, iyon po yung pinaka topic po for our research, ano po

yung parang average ng mga patient deaths na naeencounter niyo po on a weekly basis ganyan?

Participant: On a weekly basis, I couldn’t say kasi sometimes during the week wala namang

namatay. On a monthly basis, siguro 1 or 2.

R: Pero yun nga po diba, from the survey po, you answered po na you encountered na rin po na 1

to 5 patients diba po?

Participant: Yes, oo I had 1 to 5 patients kasi I was starting. But eventually kasi dumadami sila,

oo. Yung 1 to 5 kasi talaga, I guess I wasn’t expecting it, parang ganoon.

R: Within 2 years po iyon or parang mga 5 patient deaths yung na-encounter niyo?

Participant: Ok, I just like to clarify na yung 5 na yun na nalagay ko sa survey, is the one that I

really, yung nabigay talaga saking pasyente

R: Opo, tama po.

Participant: Yung the rest of the patients naman na yung na-experience ko na death is with a team.

Pero I had a direct contact and relationship with the patient before they passed away.

R: Opo, tama naman po na 1 to 5 siya…Ngayon po, I want you to think of kahit 1 patient lang po

who died who was particularly difficult for you. Ayun po, can you describe the patient to me?

Participant: Yung remark about the patient kanina, well she was female. I think she was even

younger than 18 years old. And then mayroon siyang kapatid and mom, although I didn’t see the

dad. And then noong dumating siya sa emergency room, hirap na hirap na siya. And then I noticed

her relationship with her mother parang, I don’t know if mayroon silang discord, too cold yung

approach niya sa mother niya. Yung mother naman niya is the opposite. More on caring and

concerned. And then yung patient medyo unexpected kasi during the part of my duty, ok naman

siya kasi I was doing dialysis on the patient, so ok naman siya during my 24-hour duty. And then

bigla na lang talaga the next day, I found out na lang na she passed away. I guess that was one of

the most remarkable patient kasi bata pa lang siya and she had a lot of potential. Alam naman

nating bata yan, may potential to fulfill yung dreams niya tapos biglang naputol diba just because

of that medical condition niya. So she would be my most memorable patient na na-pass on during

my care.

R: What was her condition po ba noon?

Participant: It was…wait lang I’m remembering pa…---- disease. I think mayroon na siyang

congenital kidney problem. And then, kaya she required dialysis. Kaya noong pinunta na siya sa

ER, medyo malubha na. Hindi masyadong maganda yung hitsura niya. She was already dark tapos

mahirap na siyang huminga. Eventually she looked unwell noong nakita ko siya sa ER.

R: How long po was your relationship with the patient or how long was she in your care? Under

your care pala.

Participant: Around 2 to 3 days, oo. Kasi biglaan yung death niya.

R: When she passed away po, what did you feel po during that moment? That experience na

knowing na she passed away?

Participant: Of course I was devastated kasi she was really one of the first patients na I was really

able to handle; I was able to administer the proper care based on the instructions of the senior. And

then I wasn’t really expecting it so I was shocked. And then at one point, I cried about it kasi nga

I know I was doing well what was I supposed to do. I was following the instructions with regards

the management. And then I felt na I lost hope at that moment upon finding out nga na namatay

siya. And it took me quite some time before I actually got over it.

R: What did you do po after noong ano na yun noong happening? And how did you cope with it

po?

Participant: I actually just told to few of my close friends about it, about what I was grieving. Kasi

at that time, I didn’t really know how to process it. Kasi I was really in shock and I also built a

relationship with the patient. And I would just share na I was actually with the patient for more

than 24 hours straight kasi na sa bedside lang ako niya. So alam ko yung, how the mother was

grieving, tapos yung hirap na nararamdaman ng patient during the time, during the dialysis. Kita

ko talaga yung hirap niya. Sobrang hirap niya and I had a really difficult time processing it kasi

she was really close na napalapit na ko sa kanya you know during that short time. So actually,

devastated, shocked, and then of course sad as well. And then yung part din yung explaining myself

din na I was thinking what could I have done better to prevent that siguro.

R: You think po how long po did your parang grieving lasted noon?

Participant: 2 or 3 weeks, more or less 2 or 3 weeks yon.

R: Did this loss of a patient po ba affected you emotionally?

Participant: Yes, definitely oo.

R: Professionally po?

Participant: Professionally, I guess not so much but it did affect yung work ko during the next

weeks na I wasn’t interested in my work parang na sa ibang lugar yung isip ko. I want to get it off

my head. There are times na gusto kong lumabas sa hospital kasi nga naalala ko yung mga, yung

nangyari. And parang medyo natakot din ako kasi I don’t want to go through that again. But I

know naman, eventually there could be a time na mangyayari ulit yung ganoon.

R: Has your motivation po ba to go to work been affected din noon?

Participant: Yes, definitely. There are days na I didn’t want to go on duty or I didn’t want to see

patients that were a kin to me.

R: Pati po yung the way you treat your other patients din po noon no?

Participant: Yes actually I got affected. During the first week, I felt distant na sa mga next patients

ko kasi I didn’t want to get too attached. And then I eventually realized na, you need to get back

with your patients. You need to develop rapport with them to establish a good relationship with

them in order to understand what they’re going through. They’re not only seen as patients. They’re

supposed to be seen as a human being, as a whole person with many different aspects. So

eventually, I stopped being distant, eventually the quality…I think I went back to my usual self na

I became more engaged with the patients.

R: Sa tingin niyo po ba, in what way, bakit po kaya kayo naging affected dito sa experience na ito?

Participant: I think because as doctors, we play a big part in the patient’s health. And then what

we do are decisions that affect the outcome. So more often than not, the outcome of the patient

will depend on how you really manage them. If you were able to see the problem or if there was a

problem you weren’t able to see early on and then nagkaroon ng complication because of that. So

we know naman yung patient yung relatives niya, sila yung magagalit sayo, they’re gonna be

judgemental and disappointed

R: If naalala niyo pa po doon sa survey, kasi mayroon po kami na parang self-compassion scale

doon. And you actually scored high po. Ano po yung parang take niyo po doon na bakit --- na

importante din po na mayroon kang self-compassion pagdating sa profession niyo po.

Participant: I think that self-compassion is important because as a person you also have your needs.

And as a doctor, you know that you have a duty to your patients. But it is also important to look

after yourself. And if you don’t look after yourself properly, it could affect to the way you work -

--. And then you’re handling patients, and it’s going to affect them later on. It’s bigger

than…parang it’s important to look after yourself as a doctor. It’s also going to determine how

you’re to deal with others and how you’re going to make an impact in their lives whether it’s

positive or negative.

R: How do you balance po ba you’re emotions and you’re…with your responsibilities as a doctor

po particularly regarding a dying patient or experiencing death of a patient?

Participant: I think it’s for me…you were able to take time to think, to think clearly. I think that’s

the answer you’re getting. I think it’s just taking time to absorb what’s going on in your

surroundings and being able to come up with a strategy and how to respond to whatever occasion

it may be. I think it’s more on taking time to think things through and to really think of the way

you react to different things and different people.

R: Regarding din po sa loosing a patient, do you think po how much sense did that made to you

po? Yung experience po na iyon.

Participant: I’m sorry how much what?

R: How much sense would you say you have made po?

Participant: I’m sorry medyo choppy.

R: How much sense, parang what was the meaning of it all po? What was the meaning of being

able to experience that loss.

Participant: I think for me it’s knowing that you still have a lot to learn in the medical

profession…not only in the medical profession but in life in general. And then, there are mistakes

that you can encounter along the way and it’s not so much how you react to these unfortunate

things but more on how you respond to them, you know what you can do to improve, what you

can do to prevent these things from happening. And what you can actually do to better yourself in

the lives of others. I think it’s more on really orienting yourself and trying to see, trying to weigh

things

R: What do you think po na yung pagbibigay ng meaning with this kind of experiences, what is

the use of this kapag yang naghahandle po besides sa improving yourself. And sa tingin niyo po

in life generally, what is the meaning of ayun nga po experiencing this kind?

Participant: I think it’s really making the most out of what you’re given. It’s making most of the

knowledge that you have, the time that you have, the resources that you have. Giving the best care

that you can not only to your patients but also to yourself.

R: Overall po, do you believe that you have changed as person since that experience of death.

Participant: Yes, I think I’ve changed. I’ve been more sensitive now to ---cause there were times

na I really became focused on myself, on my career, on my growth that sometimes I don’t…there

were times na I really didn’t mind other people around me. And being a medical professional and

being able to handle patients who have really difficult cases made me realize how blessed I am to

what I have. And then it’s really important to have a good sense of…it’s important to have the

support of people who love you and support you.

H12.

Participant 8 (35, Male, Pampanga)

Medical Practitioner

Years in profession: 3 years

No. of Patient Deaths: 1-5

HGRC Score: 1.41 (Low)

SCS-SF Score: 4.00

GMRI Score: 4.00

R: Good morning doc. Bale basahin ko lang po sainyo protocol namin then start na po tayo sa

intrerview?

Participant: Yes, okay go ahead.

R: (Interview Protocol)…Do you have any questions po or concerns?

Participant: Wala naman, wala naman.

R: Okay po. So before we jump into the specific research questions, can you tell me a little bit

about yourself?

Participant: Sige, I’m [redacted], everyone calls me Doc JR, 35 years old, I graduated from FEU-

NRMF. I did my internship there pati na rin yung residency, I was an Internal Medicine resident

in FEU hospital and then nag-pulmonary ako sa PHC. Now, I practice here in Pampanga and in

Manila rin. What else? Wala na ako maisip. *laughs*

R: How do you see yourself as a doctor po?

Participant: Uhm I see myself as someone who is able to help a lot or people, to treat them,

relieve them of their pain and pati na rin try to prevent my patients from getting sick. I also see

myself as very compassionate ba? Itang patse lalawen ke ing pasyente ku susubukan ku talaga na

minsan kakabit ku ing sarili ku keng sitwasyon na… at tsaka dapat pakiramdaman la.

R: Next naman po, ano po yung best aspects of being a doctor for you?

Participant: Getting to save lives and heal the diseases of my patients. Kapag nattreat ko yung

patients ko, seeing them okay again after treatment. Actually, hindi lang naman kapag

gumagaling yung pasyente kahit yung simple lang na alam kong nakatulong ako sai bang tao,

yun isa yun sa best aspects.

R: What about the most difficult aspects naman?

Participant: Most difficult aspect for me is when I know that there’s pretty much nothing I can do

about the patient’s condition. Siguro is yung kapag namamatay rin yung patient, pero mas

mahirap para sa akin kapag alam ko na hopeless na kumbaga. Kasi minsn mahirap kapag yung

family is hoping pa na magiging okay, pero ikaw sa nakikita mo wala na. It’s hard to make them

understand na wala na talaga.

R: Ohhh oo nga po. Next questuon naman po is yung sa research na po namin talaga.. On

average how many deaths of patients do you deal with on a weekly basis, and if not weekly po

on a monthly basis?

Participant: Siguro monthly dalawa or tatlo? Actually, kung bibilangin talaga marami di lang

isa, dalawa. Pero ako kasi mostly kapag may pasyente ako, di lang ako yung doctor niya,

possible na ni-refer lang sakin. Kaya di ko na cinount lahat. Sa binigay ko na number yun yung

ako talaga yung nag-aattend sakanya, ganun.

R: Ah okay po. Now, think of a patient’s death that was particularly difficult for you. Can you

describe the patient. And when did this happen?

Participant: Wait lang.. isip ako. *laughs* Hmm… ah ito I had this patient during my first year

of residency. He was a male on his 70s na yata nun. He had lung cancer and matagal-tagal rin

yung stay niya sa hospital nun so basically halos ako yung nagmomonitor sakanya. The old man

was very cheerful, medyo makwento, sobrang bait. Siguro the thing that made this death difficult

for me is I thought gagaling siya. But sadly, he expired after a few weeks din sa hospital.

R: Naaalala niyo po ba yung what you feel during the experience?

Participant: Nalungkot, ganon rin naman sa iba kong pasyente actually. I was very hopeful

initially even if I knew that he had stage IV Lung Cancer. Pero ganun talaga, totoo nga siguro

yung kapag oras mo na oras mo na.

R: What about after naman po? What did you feel?

Participant: Uhm sa naaalala ko noong day lang na yun ako nalungkot then the next day okay na.

Kailangan eh, hindi lang naman yun yung patient ko marami rin pang iba. I know I did my best

so there’s no regret in my part.

R: May ginawa po ba kayo to cope with the experience?

Participant: Nothing in particular that I remember. Nagpatuloy sa trabaho? Went on with my day.

Back to work hahaha. After noong death syempre I had to talk and explain to the family what

happened to their relative and gave them my foremost sympathy. Kind of talked to my co-

doctors about it syempre kahit paano eh bago lang pa rin ako nun, so during that time I really

find time to talk to my seniors.

R: Mhmm. So in what way do you think had this loss affect you emotionally?

Participant: Emotionally, siguro not that much. Nalungkot ako pero normal naman siguro yun for

everyone. Pero I can say na it helped me know how to handle the other patient deaths that came

after.

R: What about professionally naman po?

Participant: Halos same lang? Wala naman nagbago masyado.

R: Sa level of attachment naman po with your patients, may nagbago po ba?

Participant: Wala rin. Pare-pareho lang sa kanila, I treat them all equally and same yung level of

attachment ko sa kanila.

R: Yung motivation niyo naman po to go to work?

Participant: Motivation to go to work, no it has always been the same. Ever since, what kept me

motivated is my desire to help and treat my patients.

R: Ohh that’s amazing po like having a sense of purpose. Next naman po, if you remember…

you answered three scales for our research. One scale there is about self compassion po. Defines

as being compassionate to oneself in times of difficulty, failure, for example patient death po.

What do you think is the role of self compassion on handling patient death?

Participant: Uhm parang for me it’s very much important kasi you have to keep going eh so in

times na magkakaroon ka ng mga ganitong experiences you have to be compassionate sa sarili

mo gaya ng pagiging compassionate mo towards your patients.

R: How do you balance your emotions with your responsibilities as a doctor?

Participant: For me, parang hindi pa naman naging hindrance yung emotions ko sa pagiging

doctor ko. I’ve managed to balance these two well... but maybe I do it by reminding myself why

I’m here in the first place. Also, not being emotionally attached to the patients and their relatives.

R: Regarding meaning making naman po, how much sense of the loss have you made? If irrate

niyo po from 1 to 5.

Participant: Sorry i’m not quite familiar with the term, can you define it?

R: Uhm meaning-making po is like yung giving sense to an event na yung meaning po ng event

na yun sa sarili mo is when it happened ano po yung binigay niyo po na reason as to why it

happened. Yun po parang ganun. How much sense have you made of the loss?

Participant: Rate from 1 to 5 no? Siguro mga 3.5? Pwede ba may .5? *laughs*, maybe because I

didn’t really ponder on thinking about the experience that much. Di ako masyado naghahanap ng

reason because I see it as something that really happens. So usually when I try to make sense of

what happened, I try to think of it as something that brought relief to the patient to the family,

somehow. Kasi di na magssuffer yung patient eh pero of course yung family will be affected but

everyone naman will surely get on with life again.

R: So despite the loss po would you still say na you were able to find benefit from the

experience?

Participant: I guess in a way meron. Like I already mentioned it somehow brings relief and it sort

of reminds me na there are other people who need me rin.

R: Ano naman po yung role ng meaning making sa handling ng patient death?

Participant: Hmmm isa siguro is it helps you take care of yourself by being able to realize what

an experience has done for you, mga ganung bagay.

R: Do you believe that you have changed as a person because of that particular experience?

Participant: Yes, but this experience was just one of the things that made me who and how I am

today. Marami pang ibang bagay marami pang ibang tao, marami pang ibag experiences…

Grief in Profession: Self-Compassion, Meaning-making, and Grief from Patient Death

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