“DIGGING DEEP ON THE PERCEPTION OF EMERGENCY DEPERTMENT NURSES OF

HOSPITALS IN TUGUEGARAO CITY ON THE ADVERSITY OF CLIMATE CHANGE AMONG

THE ELDERLIES: A BASIS FOR IMPROVING THEIR ADAPTATION TO CLIENT NEEDS”

A Research Proposal Presented

to the Faculty of School of Health and Allied Sciences
University of Saint Louis
Tuguegarao City, Cagayan Valley

In Partial Fulfillment
of the Requirements for the Degree
BACHELOR OF SCIENCE IN NURSING

By:
Jomarie S. Cabrera, SN
Naomi Leda R. Palma, SN
Ethelle Margarette L. Reyes, SN
ABSTRACT

This study aims to explore the perceptions of emergency department nurses of

secondary hospitals in Tuguegarao City on the adversity of climate change among the elderlies.
The study will make use of a Qualitative Interpretative Phenomenological Research design
following the Heideggerian school of thought. Interpretative phenomenology emphasizes
understanding and interpreting human experience and not merely describing them. This design
will help the researchers understand fully the lived experiences and perceptions of the nurses
and to enter their world to discover their practical wisdom, possibilities and understandings. The
researchers will make use of in depth interview to know the nurses’ extent of knowledge and
beliefs regarding climate change, their lived experiences, roles and barriers in addressing the
health related problems of the elderlies affected by the climate change. The researchers will
involve Emergency Department nurses: 1) who work in the Emergency Department for at least 1
year at present, 2) who could express thought clearly in either English or Filipino language; and
3) who manifest interest in the research study. The interviewwill be recorded and documented
using audio recording devices. Data gathered on the interview will then be analyzed using the
Colaizzi Method. Therefore, results generated will be utilized in the discernment of the
perceptions of emergency department nurses of secondary hospitals in Tuguegarao City on the
adversity of climate change among elderlies.

Keyword:climate change, emergency department nurses, perceptions, adversity of climate

change, interpretative phenomenology, Colaizzi Method
INTRODUCTION
Climate change includes significant statistical distribution of the weather condition. Such
changes affects the physical environment and human health changes on the weather condition
results to extreme weather events, decrease air quality and diseases (Gamble and Hurley,
2013). Vulnerable population affected, includes elderly due to deterioration on the physical
condition and immunity as they age. When these elderly individuals are affected by these
diseases, they must be brought for consultation to the clinic or emergency department it is the
role of emergency department nurses to assess the history prior to consultation. In its sense
and based from the concept of this research study, it is crucial for emergency department
nurses to look into the significant role of the changes on the weather condition to the health
status of the elderlies.
One of the healthcare facilities the elderlies run to is the Emergency Department for
immediate care. That is why emergency department nurses are challenged to provide safe,
quality care to the elderlies (Cronin L., 2010). Nurses’ actions towards climate change depend
on their personal commitment and understanding of the phenomenon. These nurses need to be
aware of how climate change affects human health to help them address the health problems
appropriately. A research observed significantly elevated cases of cardiovascular diseases
among elderly during transitional seasons and summer in New York (Li, 2015). Another
research also stated that due to increasing level in ground level above and higher
concentrations of fine particles such as dust and pollen, respiratory impairments such as
asthma incidences arises (Gamble, 2013). The elderlies are dependent on their significant
others as well as health care providers for support.
The elderlies are affected, not only because Tuguegarao is the hottest city in the
Philippines, as shown by the recorded temperature of 37.9 oC last April 2014, but also is greatly
affected by climate change. On that note and with the purpose of exploring emergency
department nurses’ perceptions on the adversity of climate change among the elderlies, this
research will be conducted.
Research Questions

This research study investigates the perception of emergency department nurses of secondary
hospital on the adversity of climate change among the elderlies.
Specifically, this study will answer the following questions:

1. How do emergency department nurses perceive climate change?

2. What is the role of Emergency Department nurses in addressing the healthcare

problems of the elderlies brought about by climate change?

3. What are the lived experiences of emergency department nurses on the adversities of
climate change among elderlies?

4. What are the barriers experienced by emergency department nurses in identifying the
adversities of climate change among elderlies?
Significance of the study

This research study further increases awareness of the people about the adversity of
climate change, not just among the elderlies, but among the people in general through the eye
of emergency department nurses. This awareness leads to the adherence to the different health
and environment advocacies introduced to them so they may become more responsible of their
health and environment. This study will also be a significant endeavor in increasing the
knowledge and awareness of emergency department nurses about climate change and its effect
on elderlies especially on the health aspect of the clients. Knowing this leads to helping the
emergency department nurses in identifying the adversities of climate change among elderlies
and its barriers that may affect the recognition of the problem in the health condition of the
client. It would also lead them to how to intervene and address the health needs of the elderlies
effectively. Lastly, this study will be a significant endeavor in helping the nurses adapt to client
needs and in improving and empowering nursing care.

Literature Review

Theoretical Underpinning

Florence Nightingale defined nursing as “the act of utilizing the environment of the
patient to assist him in his recovery” (McEwen, p. 54, 2002). It involves the nurse’s initiative to
configure environmental settings appropriate for the gradual restoration of the patient’s health,
and that external factors associated with the patient’s surroundings affect life or biologic and
physiologic processes, and his development. As to the climate changeis already beginning to
transform life on earth, around the globe, seasons are shifting, temperatures are climbing and
sea levels are rising. The likely impacts of climate change include challenges to public health.
As stated by Florence “nursing has to put the patient in the best condition for nature to act upon
him”, it is the responsible of the nurse to utilize the environment in-order to restore the health
condition of the client (McEwen, p. 54, 2002).
Climate change and its effects on human health
Climate change poses a major threat in our health nowadays (Renouf F. et al, 2016;
Bouzid B. et al, 2013). It currently contributes to the global burden of disease and premature
deaths (Confalonieri L. et al, 2007). Human beings are exposed to climate change through
changing weather patterns like temperature, precipitation, sea-level rise, more frequent
extreme events, indirectly through changes in water, air and food quality and changes in
ecosystems, agriculture, industry and settlements and the economy (Confalonieri L. et al, 2007;
Haines B. et al, 2016; Abbas P. et al, 2009)

Climate is a major factor controlling ecosystem variability and therefore the potential for
outbreaks of certain diseases (McMichael J. et al, 2007; Comrie E.N., 2007). According to
Comrie (2007), examples of climate-related diseases includes aeroallergens, fungi, water- and
food-borne diseases, influenza, rodent-borne diseases, vector-borne disease and insect-borne
diseases. Also, according to Patz, Lendrum, Holloway& Foley(2013) many prevalent human
diseases are linked to climate fluctuations, from cardiovascular mortality and respiratory
illnesses due to heatwaves, to altered transmission of infectious diseases and malnutrition from
crop failures.

According to WHO report (2015), climate change also affects the social and
environmental determinants of health like clean air, safe drinking water, sufficient food and
secure shelter. They also listed some factors of climate change that affect the health of
humans, first is extreme heat, extreme high air temperatures contribute directly to deaths from
cardiovascular and respiratory disease particularly among elderly people (WHO, 2015).
Another is Natural disasters and variable rainfall patterns, rising sea levels and increasingly
extreme weather events will destroy homes, medical facilities and other essential services and
people may be forced to move, which in turn heightens the risk of a range of health effects,
from mental disorders to communicable diseases (WHO, 2015).

Climate change and the elderlies

Elderlies are consistently identified as a population that is especially vulnerable to
climate change stressors (Gamble J. et al, 2013; Oudin A. et al, 2011; Yu W. et al, 2012;
Filiberto D. et al, 2011). Also according to Filiberto (2011), they are the most at risk because of
decreased mobility resulting from age, changes in physiology, and more restricted access to
resources, all of which may limit adaptive capacity. The health effects of climate change on
older people can be classified into two categories: (1) those due to the greater exposure of older
people to the threat and (2) those that are a combination of exposure plus greater reactivity as a
characteristic of aging like increased physiological susceptibility or social factors that vary
across individuals like social vulnerability (Gronlund C. et al, 2014; Filiberto D. et al, 2011;
Kenney W. et al, 2014).

The impact of climate change on the health of vulnerable groups such as the elderly has
been of increasing concern (Mengersen K. et al, 2012; Wethington E. et al, 2011). The oldest
old, age 85 and over, are more likely to suffer negative health effects from climate change (Haq,
Whitelegg, and Kohler, 2008) because of physical decline or frailty (McGeehin and Mirabelli,
2012). Those individuals who suffer from multiple pre-existing chronic conditions that limit
mobility and those who take medications that increase susceptibility to heat, pollutants, and
vectorborne diseases are more at risk because of those factors (Geller and Zenick, 2008; Haq
C. et al, 2008).

The greater physiological susceptibility and social vulnerability may best account for
many of the negative health effects of climate change on older people. The effects of climate
change are variable, depending on pre-exposure health status, psychological well-being, and
social characteristics (Geller G. et al, 2005). Indeed, turning age 65 does not in itself make a
person more vulnerable to the negative effects of climate change. Rather, it is the individual
physiological and social factors associated with aging that may bring greater negative impact
(Stein et al., 2008).

Better knowledge about how to assist older people and minimize their susceptibility to
the hazards resulting from climate change is urgently needed. Older people require better
information regarding environmental threats to health (IPCC, 2007; Paavola and Adger, 2006).

Climate change and nurses

Climate change and its implications for human health represent an increasingly important
issue for the healthcare sector. Nurses have a responsibility to be involved and support climate
change mitigation and adaptation to protect human health (Anaker A., 2015; Polivka B.J., 2012
and Barbara H. A., 2011). Adverse health impacts of climate change will affect health systems
and health care delivery (Lander A. B., 2009 and McKorvich et al, 2008).
 Nurses are concerned that climate change can affect human health, such as through
impacts of heat stress, death and injury due to floods and storms, changes in disease patterns
and in the ranges and numbers of disease vectors, such as mosquitoes, water quality, air
quality, and food availability and quality (Bargagli A., 2009; Schifano V.G., 2008 and Paldy, A.
2009).

Nurses need to increase awareness of issues and methods that are crucial for the
healthcare sector to respond to climate change. Efforts to develop interventions should explore
how nurses should be able to contribute to the healthcare sector's preparedness for and
contributions to sustainable development (Chaudry V. et al, 2012; Tapper N., 2014; and
Ghirardi, L., 2015). The World Health Organization similarly says preventative public health
measures must be intensified and must become the core of sustainable development (WHO,
2009). Nurses should have a greater role in illness prevention and health promotion in clinics
and in people's homes rather than in hospitals (Barlow G., 2008). Skills that help nurses to think
critically and ethically in crises are vital including key nursing skills in assessment, prioritising
care and communication when educating our student nurses, however more research is needed
so that nurses can better understand how to prepare and protect patients and ourselves in the
unpredictable times ahead (Barlow G., 2008 and Nilsson M., 2015). Nurses and other health
care providers are qualified to bring information on climate change to the public because they
have both the necessary scientific background and the communication skills to get the message
across in an understandable way (CNA, 2008). Nurses can also play a major role in emergency
planning or preparedness for climate changes, including involvement of nurses at all levels of
government planning (ANA, 2009). Their expertise in health promotion and behavior change
also allows them to promote lifestyle choices that will decrease greenhouse gas emissions by
individuals, families, and communities (Rosemary V. et al, 2008 and CNA, 2008).

Climate Change in the Philippines

The Philippines is considered as one of the most vulnerable countries in the world due to
its archipelagic make-up and location (Tacio H., 2010). The country ranked first as most
vulnerable to tropical cyclone occurrences and ranked third as to the people exposed to these
seasonal events worldwide (World Disaster, 2012). Philippines hosts an average of 20 typhoons
yearly and faces increasing disaster risks with geologic/seismic dangers closely interacting with
meteorological hazards (PAGASA, 2015). The Philippines ranked 6th as most extremely
vulnerable country to climate change using the Climate Change Vulnerability Index (CCVI)
among 170 countries covered worldwide (Maplecroft, 2010). The high variability in the trends of
climactic parameters over the past decades attest to the occurrence of climate change in the
country like droughts during El Nino episodes and floods during La, spikes in temperature and
warming in the northern and southern parts of the country with experiences of hotter nights and
days, occurences of forest fires more frequently, and precipitation trends in other parts of the
country were highest at 10% in the 20th century (PAGASA, 2015). Extreme weather events
such as fatal typhoons, flash floods, landslides are have become the new normal. Typhoon
Ondoy in 2009 devastated Metro Manila with 334mm of rains flooding the National Capital
Region (NCR) in just six hours compared to the 1967 typhoon that brought the same area 334
mm of rain in 24 hours (Juanillo E., 2010). These, in turn, are expected to impact on the
vulnerabilities in the country’s food and water security, environmental and ecological stability,
energy use and infrastructure, and human security (DOH, 2014).
Research Simulacrum

EMERGENCY
DEPARTMENT
NURSES

Climate Change

ELDERLY
PATIENTS

Climate Change and Emergency Department Nurses and Climate Change both can
affect the elderly patients. Climate change is the onset of cold and hot weather in a span of
time. Climate change can directly affect the elderly patients’ health. Elderly patients have
deteriorating immunity because of their age. Climate change takes advantage of this
vulnerability and both the cold and the hot cause changes to the health of the elderly patients.
Emergency Department Nurses do not have control over the climate, but they can intervene in
making the patients free of sickness that are and aren’t related to climate change. ED Nurses
can cause changes to the elderly patients just like climate change. With the knowledge and
skills of the nurses, appropriate nursing intervention will greatly affect the complications caused
by climate change to the elderly patients.

METHODS

This phase of the research study presents the description of the methods to be used in
this research study, the participants, and the data gathering procedure and data analysis.

Research Design
 In order for the researchers to determine the perception of Emergency Department
Nurses in hospitals on the adversity of climate change among the elderlies, the researchers will
be conducting a qualitative research study. The researchers will adopt an interpretative
phenomenological research following the Heideggerian school of thought. Interpretative
phenomenology emphasizes understanding and interpretating human experience and not
merely describing them. This design will help the researchers understand fully the lived
experiences and perceptions of the nurses and to enter their world to discover their practical
wisdom, possibilities and understandings (Polit & Beck, 2014).

Locale of the Study

This research study will be conducted in Emergency Department of Tuguegarao City

specifically among nurses.

Participants of the Study

The researchers will involve Emergency Department nurses:

1. Who work in the Emergency Department for at least 1 year at present
2. Who could express thought clearly in either English or Filipino language; and
3. Who manifest interest in the research study

Data Gathering Procedure

Prior to the conduct of this research investigation, the researchers will seek permission
from the university through the academic dean of the concerned school/department, the
University Research Center (URC) through the research director, for the conduct of research.
The researchers will then identify possible participants of the research basing from the criteria
stated. Convenience sampling will be utilized in choosing the participants of the study. The
researchers will then seek the permission of the participants and the respective hospital
administrator where the study is to be conducted.

As the research is a qualitative study, the researchers will make use of in depth interview
to gather data from the participants. After the researchers asked for the permission of from the
respective hospital administrators, she will acquire the schedules of the nurses who meet the
criteria to become participants. The researcher will then set the schedule and place for the
interview according to the convenience of the nurses to ensure satisfactory data collection.

A structured interview will be utilized that aims to know the extent of knowledge and
beliefs regarding climate change, their lived experiences, roles and barriers in addressing the
health related problems of the elderlies affected by the climate change.

Before the interview, the participants will be informed on what the research is all about.
An informed consent will be given to the participants for them to willingly sign after providing all
the information necessary. During the interview, the researcher will use a voice recorder to
document the responses of the participants with their permission. The researchers are also
guaranteed of their anonymity and that all recordings and information gathered from them will
be confidential and deleted after the study. The data will be sorted and analyzed. After the data
is analyzed, the researcher will return to the emergency department nurses for observation to
confirm if the analysis done by the researchers are consistent with their perceptions.
Data Analysis
 In this research study, non- statistical qualitative data analysis will be utilized based from
gathered lived experiences of the respective participants.
Malagon-Maldonado (2014) and Polit & beck (2008) asserts that Qualitative Data
Analysis involves certain stages specified in Colaizzi’s method with the following steps:
(1) Transcribing interviews and sorting field notes are the initial steps in gathering
detailed information from informants through interviews by writing verbal statements
and audio recording or both.
(2) Organizing data is putting altogether the sorted information in order emphasizing the
time, place and location but disregarding the informant’s personal information. This
includes all field notes, memos, journals and audio records used in information
collection.
(3) Listening to and reading documents begin the data analysis process. It is the
reviewing of the information collected from informants.
(4) Codes are used and emerged by the researches in coding and categorizing data by
marking sections of the data or assigning labels and inserts phrases or words to
develop a concept from the collected information accordingly
(5) Building themes means significant data are being classified and organized in a
systematic form to develop categories, themes, or major constructs adapted from the
information gathered.
(6) Describing a cultural group defines the group or the belongingness of the informants.
It partly defends the reason or logic of the informant’s information.
(7) Describing a phenomenon is the detailed summary of the collected information in
answering the concept of the study through participant checking or inquiry and final
validation of the steps in qualitative data analysis.

Rigour of the study

The researcher will utilize member checking as validation method for the data gathered.
After the data is analyzed, the researcher will return to the Emergency Department nurses to
confirm if the analysis done by the researchers are consistent with their perceptions.
Ethical Consideration

This research study is voluntary. The researchers assured the participants that
anonymity of their identity and confidentiality of information will be protected. All field notes and
records of participants’ profile were destroyed at the conclusion of the study. The researchers
also emphasized that they could still withdraw participation even amidst the research
investigation.

RESULTS
Climate change and its implications for human health represent an increasingly
important issue for the healthcare sector. Vulnerable population affected, includes elderly due to
deterioration on the physical condition and immunity as they age. One of the healthcare facilities
the elderlies run to is the Emergency Department for immediate care. Emergency Department
nurses need to address climate change and its potential implications. Nurses’ actions towards
climate change depend on their personal commitment and understanding of the phenomenon.
In this research study, in depth interviews with guide questions with Emergency
Department Nurses of the hospitals in Tuguegarao City were utilized to know the extent of
knowledge and beliefs regarding climate change, their lived experiences, roles and barriers in
addressing the health related problems of the elderlies affected by the climate change.

Upon comprehensive analyses of the lived experiences of the Emergency Department

nurses, essential information from the interview were recorded using an audio recorder for
accurate and precise data.

Utilizing Colaizzi’s method of qualitative phenomenal interpretative study (Polit & Beck,
2008), four themes were created and organized emphasizing the main substance of the
collected data conforming to the research study questions correspondingly.
Theme 1:Perception of Climate Change. Emergency Department Nurses were asked about
their perception regarding climate change through expressing their personal understandings to
the meaning of climate change, its possible causes and its effect on human health particularly
on the elderlies.
1. What is the meaning of climate change for you?
Respondent 1
Para sa akin ading e ang meaning ng climate change e yung
pagbabago ng panahon o di kaya ng klima natin for example e
dito sa tuguegarao pag umaga e sobrang init tapos mamayang
hapon biglang nalang uulan ng pagkalakas lakas.
[For me climate change refers to the changes in the weather
or climate. For example here in Tuguegarao, in morning we
experience extreme heat and then in the afternoon there will
be a heavy rain.]
Respondent 2
Ito yung biglang pagbabago ng climate natin dahil sa mga
harmful human activities na ginagawa natin sa ating paligid
katulad nalang ng pagsusunog ng mga plastic at pagpuputol
ng mga puno.

[It is the sudden change in the weather because of the harmful

human activities that we do in our environment like burning
plastic and cutting down trees.]

Respondent 3
Climate change is caused by human practices like cutting
down trees, pagsusunog tsaka pollution then nag li lead ito sa
 destruction ng ating ozone layer na siyang reason kung bakit
mainit dito sa atin ngayon.

[Climate change is caused by human practices like cutting

down trees, burning and pollution that can lead to destruction
of our ozone layer which is the main reason why we
experience increase temperature today.]

Respondent 4
“Climate Change? E di yun pagbago ng climate o weather
natin. Unstable bigla na lang iinit tapos uulanng malakas. For
example pag sobra init nagiging El Nino. Tapos kapag bigla
nalang sobrang lakas ng ulan La Nina naman yun.”

[ Climate change? This is the change in climate or weather

and becomes unstable. The weather is very hot this time then
it would suddenly rain heavily. For example extreme heat
could lead to El Nino while severe rain could lead to La Nina]

Respondent 5
“Ito yung ano biglaang pagbabago sa pattern ng climate natin.
Parang ano bigla nalang uulan kahit sobrang tirik ng araw.
Tapos ito din yung panunuyo ng lupa kaya madaming tao o
magsasaka ang nadidismaya dahil nawawalan sila ng hanap
buhay”

[ Climate change is the drastic change of climate pattern. Like

for example is the sudden occurrence of heavy rain even
though we are experiencing hot weather. And it is also the
prevention of upwelling of nutrient rich cold deep water that’s
why many farmers are dismayed because they experience
loss of income.]

Respondent 6
Climate change is yung biglang pabago bago ng weather
natin. For example may mga araw na nararanasan natin yung
sobrang init o yung tinatawag natin na El Nino tapos may mga
araw din na ulan lang ng ulan o yung La Nina.

[Climate change is the drastic change in our weather. For

example we experience extreme heat or what we call El Nino
and then there also days that we experience heavy rain or
what we call La Nina]
Respondents 7
Climate change is a natural phenomena on earth, ito yung
mechanism ng earth para maka adopt sa changes that are
happening in the environment.
[climate change is a natural phenomena on earth this is a
mechanism to adop to the changes that are happening in the
environment]
Respondent 8
Kapag abnormal na yun panahon di ba. Pabago pabago.
Minsan sobra init tapos biglang uulan ng malakas. Iba na
talaga yun weather ngayon. Hindi na kaya ng tao

[The weather is not normal. It changes frequently. Sometimes

the weather is extremely high then it would suddenly rain
heavily. The weather is very different nowadays. It cannot be
tolerated by the people anymore]
Respondents 9
Pag climate change, di ba yun temperature ng earth e above
or below na sa normal range. Pwedeng sobra lamig pwede
naman yun sobra init. Kasi dahil may defect na sa ozone
layer natin kaya di na masyado napoprotectahan yun earth
natin sa init at lamig.

[in climate change, the temperature on the earth is either

below or beyond the normal range. It can either be extremely
hot or cold. Because there has already a defect in our ozone
layer, it can no longer serve its full purpose in protecting the
earth]
Respondents 10
Climate change is the change in weather due to increase in
atmospheres carbon dioxide. Actually diba climate change is
the effect of global warming kaya nakakaranas tayo ng
climate change because of global warming.
[Climate change is the change in weather due to increase in
atmospheres carbon dioxide. Actually climate change is the
effect of global warming that’s why we are experiencing
climate because of global warming.]
Respondents 11
 Kapag may climate change, meron tayong weather na
sobrang init tapos sobra lamig naman. Yun weather na hindi
usual. Kasi dati hindi naman ganito e. Tolerable pa yun init.
Pero dahil sa climate change, sobrang init na di na kaya ng
tao.
[When there is climate change, our weather is extremely high
and low. The weather is unusual and it is now different from
the condition before. The hotness of the weather is tolerable
before but because of climate change that is currently
happening, people cannot tolerate the hotness of the weather
anymore.]

2. What do you think causes climate change?

Respondent 1
Syempre human activities ading for example e pagsusunog ng
mga plastic e pwede namang magrecycle nalang kasi mas
nakakatulong pa yun at di pa tayo makakadagdag sa pollution.

[Of course it is because of human activities like for example

burning of plastic. We can just recycle it and it will also be a
big help and we lessen the occurrence of pollution.]

Respondent 2
Katulad ng sinabi ko kanina dahil ito sa mga human activities
na ginagawa natin na nakakaapekto sa ating environment
katulad ng pagsusunog ng plastic at pagpuputol ng mga puno
at global warming.

[Like what I have said a while ago climate change happens

because of the human activities that we do that will affect our
environment like burning of plastic and cutting down trees and
global warming.]

Respondent 3
I think the leading cause of climate change is yun nga yung
mga wrong practices natin like nagcocontibute tayo sa
pollution, and cutting trees, illegal logging and ito yung mga
reason kung bakit nasisira ang earth o yung environment
natin.

[I think the leading cause of climate change the wrong

practices that we do that contributes to the pollution, and
 cutting trees, illegal logging this is the reasons why earth and
our environment are destroyed.]

Respondent 4
E di yun sobrang daming carbon dioxide sa hangin. Yun
greenhouse effect. Yun mga ginagamit natin aircon tsaka ref di
ba ang init sa likod nun. O tapos yun mga aerosols natin,
pabango, madami pa. Yung tambutso ng mga sasakyan natin
pati mga tricycle.

[Excessive carbon dioxide in the air and the greenhouse effect

cause climate change. The electronics we use such as
airconditioning units and refrigerators emit heat at the back.
The aerosols and perfumes that we use are also contributing
factors. The vehicle exhaust of our cars and the tricycles also
cause climate change.]

Respondent 5
“Madami a, madami yung mga pwedeng possible factors diyan
kagaya ng ano pollution, pagpuputol ng mga punong kahoy, at
ano sobrang paggamit sa koryente kagaya ng hindi
pagtanggal ng saksakan ng mga bagay na hindi naman
ginagamit. At mga ginagawa nating mga tao like mga
pagsusunong ng mga plastic at pagtapon ng basura kung
saan saan. Kaya dapat matuto kasi tayong mag recycle kasi
kahit mallit na bagay lamang ito atleast nakakatulong tayo
para maiwasan ang climate change.”

[Many possible factors causes climate change like pollution,

cutting down of trees and not properly using of electricity like
for example unplugging of gadgets or things that are not being
use. And also some human activities like burning of plastics
and throwing of garbage anywhere. We should also learn how
to recycle because even the smallest things we do can help in
avoiding climate change.]

Respondent 6
Ang una sa mga causes siyempre is yung mga human
activities natin na nagcocontribute sa climate for example nito
is yung mga pagsusunog natin tsaka nakakadagdag din sa air
pollution yung sa mga sasakyan natin sobrang dami ba naman
ng mga sasakyan dito sa Tuguegarao, sobra talaga ang
pollution. Isa pang example e yung illegal na pagpuputol ng
mga puno natin.
 [The main cause of climate change are human activities that
contributes to climate change for example burning and
vehicular emission that also contributes in air pollution.
Another example is illegal logging of trees. ]

Respondent 7
I think I”ll better use the word global warming as the effect of
climate change. And ito din yung heat that are trap at our
stratosphere which can not bounce outside the earth at saka
ano e over usage ng carbon and greenhouse gasses.
[I think I”ll better use the word global warming as the effect of
climate change. And this is also the amount of heat that trap at
our stratosphere which can not bounce outside the earth and
this is also due to the over usage of carbon and greenhouse
gassess.]
Respondent 8
Tao din naman ang may kasalanan di ba. Kaya na popollute
ang environment natin. Kaya nagkaka climate change. For
example, yun mga sasakyan natin. Masama yun nilalabas ng
tambutso napupunta sa hangin. Kapag nagsamasama tapos
masyado na madami, yan ang nakakacause ng climate
change.
[Thea fault is in the people. People are the ones polluting our
environment that's why there is climate change. For example,
our vehicles are emitting harmful gases to the air. If these
gases are accumulated and excessive in amount, it will cause
climate change.]
Respondents 9
Nakaka cause yun pagsusunog ng oil tsaka katulad ng mga
magsasaka. Yun kaingin. Di ba pag nagsusunog tayo nag
eemit tayo ng greenhouse gases particularly pinakamadami
jan yun carbon dioxide. Kapag masyado ng madami, yan yun
nakakasira sa environment natin e kaya nagkaka climate
change.
[the burning of fossil fuels and also the burning done by the
farmers or what we call the kaingin contribute to the climate
change because burning emits greenhouse gases particularly
the carbon dioxide. Excessive amount of carbon dioxide
causes damage to our environment and contributes to climate
change.]
Respondent 10
 “There are so many factors leading in climate change like for
example pollution, deforestation and destruction of ozone
layer. Tayo din kasing mga tao matitigas ulo natin puro sarili
natin ang ini iisip natin.

[There are so many factors leading in climate change like for

example pollution, deforestation and destruction of ozone
layer. We people ourselves are hard headed and we just
always think of the goodness of ourselves.]
Respondent 11
Siguro yun kagagawan din ng tao ang kasalanan. Paggamit ng
fossil fuels, tapos yun usok na nanggaling sa mga tricycle and
sa mga sasakyan tapos yun mga factories yun ineemit nilang
usok tsaka illegal logging o yun pag putol ng mga puno. Dahil
kulang na tayo sa trees, wala na magaabsorb ng carbon
dioxide na nasa hangin tapos kulang na rin sa oxygen.

[The human acts cause climate change like usage of fossil

fuels, emission of smoke from the exhaust of our cars and
tricycles and even the factories. People also engage in illegal
logging or the cutting down of trees. Because we now have
fewer trees, there will also be fewer absorption of carbon
dioxide and production of oxygen in the air.]

3. Do you believe that climate change is already happening in your local region?
Please site some evidence.
Respondent 1
Oo naman ading. For example e sobrang init dito sa
tuguegarao tapos biglang pabago bago pa yung weather
kagaya ng uulan ng malakas tapos minsan naman e
nagkakaroon pa ng baha.

[Yes of course. For example we experience extreme heat here

in Tuguegarao and drastic change in weather and then
suddenly we experience heavy rain that can cause floods.]

Respondent 2
Oo naman. Katulad ng sobrang init na panahon tuwing
summer compared mo sa usual na nararansan natin na
climate pag hindi summer. Tsaka may tinatawag na tayo
ngayong La nina at El nino na sobrang nakakaapekto sa
climate at mga tao ngayong panahon.
 [Of course. Like the increasing temperature we experience
during summer compared to the usual temperature we
experienced. And today we have the so called La nina and El
nino that is very harmful in our climate and people nowadays.]

Respondent 3
Yes. One of the example of this change is yung extreme hot
and cold weather na nararanasan natin tuwing December
tsaka summer. Tapos yung mga narural disaster like floods,
earthquake, tsaka lanslides.

[Yes. One of the example of this change is the extreme hot

and cold weather that we experienced during December and
summer. And also the natural disaster such as floods,
earthquake and landslides.]

Respondent 4
“Oo naman. Feel na feel na natin. Yun weather natin dito sa
Tugue extremes di ba. Parang nasa loob ka ng oven. Tapos
sobrang polluted na ng hangin natin ditto syudad”

[Of course. We are already experiencing it. Here in

Tuguegarao, our climate is very extreme. It feels like we are
inside an oven because of extreme heat. The air is also
polluted in the city.]

Respondent 5
“Yes, parang ditto sa Tuguegarao na ngalang climate change
is already very evident. For example yng weather na
nararanasan natin ngayon maganda tapos mamaya biglang
uulan ng malakas. Hindi ko na nga maintindihan ang
nangyayari o pagbabago sa klima natin e.

[Yes, just like here in Tuguegarao climate change is already

very evident . For example the weather we are currently
experiencing sometimes the weather is fair then abruptly
heavy rain will follow. I cannot already understand the
changes in our weather condition.]
Respondent 6
Of course it is happening now, nararanasan na naman natin
yan ngayon. Kagaya ng sabi ko kanina yung El Nino tsaka La
Nina. Yung iba pang natural disasters like yung baha, bagyo,
lindol.

[It already happening and we are already experiencing it. Like

El Nino and La Nina and other natural disaster like flood,
typhoon and earthquake.]

Respondent 7
Yes, kagaya ng strong typhoons that are being formed in the
pacific, tapos pag taas ng sea water and biglaang pag ulan
kahit sobrang init ng panahon.
[yes, for example strong typhoons that are being formed in the
pacific, and the rising level of sea water and drastic rain fall
despite of having a hot weather.]
Respondent 8
Oo naman. Dito sa Tuguegarao sobrang init di ba. Dati nasa
35-37 degree celcius lang tayo e. Ngayon tumatama na tayo
sa 42-45. Tapos kahit ganyang kataas ang temperature bigla
parin uulan ng malakas sa atin. Daanan pa tayo ng mga
malalakas na bagyo.
[Of course, here in Tuguegarao, we are experiencing an
extreme hot weather. Before our temperature ranges from 35-
37 degree celcius. But nowadays, our temperature could hit
42-45 degree celcius. And even if the the weather is extremly
high, sometimes heavy rain could suddenly happen. Also,
typhoons usually land on our area.]
Respondents 9
Oo, dito palang sa atin kitang kita mo na yun climate change.
Kahit gabi mainit. Sobra yun pag ulan tapos sobra din init
naman. Meron tayo tag tuyot or yun drought. Tapos poor air
quality kasi hindi na fresh yun nalalanghap natin puro usok na
sa kalsada.
[yes. In our locality, we can already witness and experience
climate change. We now have warm nights, extremely high
temperature, heavy rains, and drought. Climate change also
affects the quality of air we breathe. The air we breathe is
polluted and we can even inhale the smokes in the streets]
Respondents 10
Yes, for example the unbearable heat of environment and the
irrational weather conditions. Kagaya ditto sa tugue diba
sobrang init kung pwede lang buhatin ang aircon hahaha. At
ano narin may evidence na ng tagtuyot tapos bigla bigla uulan
tapos baha na agad.

[Yes for example the unbearable heat of environment and the

irrational weather conditions. Just like here in tuguegarao the
weather is too hot if only I could carry the airconditioner always
. And there’s already an evidence of El nino then and the
sudden rainfall and afterwards flood.]
Respondents 11
Oo naman tinatanong pa ba yun. Ang init init dito sa
tuguegarao parang buong taon summer sa sobrang init. Tapos
pag uulan naman sobra lakas bigla na lang babaha.
[Of course, that is unquestionable. Here in tuguegarao, it feels
like summer all year round. And when it rains, it is very heavy
and continuous that sometimes cause floods.]

4. What do you think are the effects of climate change on human health
particularly on elderlies?
Respondent 1
Alam naman natin as nurses diba na mas vulnerable ang mga
matatanda sa mga sakit katulad ng hypertension at impacts ng
climate change tulad ng sobrang init at sobrang lamig di mo
maalis na magkaroon ng mga sakit ang mga matatanda kung
ganito naman ang weather natin.

[As nurses we already know that elderlies are more vulnerable

to acquire diseases like hypertension and they are also easily
harmed by the impact of climate change like extreme heat and
extreme cold and you can’t avoid the occurrence of diseases
in elderlies if our weather is like this.]

Respondent 2
Yung mga matatanda talaga ang naaapektuhan ng climate
change dahil sila yung mga taong less likely na makapag cope
sa extreme weather na nangyayari ngayon like tag lamig at tag
init.
 [Elderlies are really the most affected in climate change
because they are the ones who is less likely to cope from our
extreme weather that we experienced now like the cold
season and hot season.]

Respondent 3
Well some of the effects of climate change on human health
especially sa mga elderlies is yung extreme heat that causes
them to get easily sicked. Tsaka one example pa ng sakit na
nakukuha dahil dito is CVA, Pneumonia and Lung disorders.

[well for me of the effects of climate change on human health

especially on elderlies is the exreme heat that causes them to
get easily sicked. Another example of dieases that we can get
is CVA, Pneumonia and lung disorders.]

Respondent 4
Syempre dumadami yun number or incidence ng health
problems. Madami nagsusulputang sakit. Dengue, Malaria,
Leptospirosis, Cholera, Stroke tapos Asthma pa.

[The number of incidence of health problems increases. A lot

of diseases are emerging during climate change such as
dengue, malaria, lepstospirosis, cholera, as well as asthma.

Respondent 5
Yung iba nakaka experience sila ng dehydration dahil sa
sobrang init, heat stroke tsaka ano stress.

[Some experiences dehydration because of too much heat,

some stroke and some experiences stress. ]

Respondent 6
Syempre as a nurse alam natin na madaling kapitan ng sakit
ang matatanda. Mas lalo na ngayon at tag init andaming sakit
na pwedeng makuha ng mga matatanda kasi hindi na sila
madaling makapag cope sa papalit palit ng weather natin.
Kaya yung mga sakit katulad ng hypertension ito yung mga
karaniwang sakit na nakukuha ng mtanda sa ngayon.
 [As a nurse we are already aware that elderlies are prone to
illness. Especially now that the weather is unbearable there
are so many diseases they could actually acquire and because
of their old age they cannot cope up easily with the abrupt
changes in weather condition. And now hypertension is the
common illness that elderlies experienced.]

Respondent 7
Dahil diba sa deterioration ng immune system ng elderlies e
nagkaka experience sila ng hypertension. And diba dahil sa
biglaang pagbabago ng klima e nakakaranas sila ng
respiratory illness like asthma, pneumonia and lung disorders.
[Because of the deterioration of the immune system of
elderlies they happened to experience diseases like
hypertension and because of the drastic change in weather
they happened to acquire respiratory illness like asthma,
pneumonia, and lung disorders.]

Respondent 8
Syempre kapag biglaan yun pagbabago ng panahon katulad
ng biglang paginit tapos biglang lalamig. Syempre
magkakasakit yun nga matatanda kasi mahina yun resistensya
nila. Kadalasan dehydrated sila, o kaya nagkakasipon at ubo,
tumataas yun blood pressure nila tapos syempre heat stroke.
[ When the weather suddenly changes from extreme heat then
to extreme cold, the elderlies will easily get sick because their
have weak immune resistance. They usually get dehydrated,
cough and colds, hypertensive and of course heat stroke.]
Respondents 9
Ay madami a. Example pag sobra init, napapanis kaagad yun
pagkain kaya nagkaka food borne diseases kasi since
matanda na sila decreased na yun gastric acid production nila
kaya madali silang tablan. Kapag sobra extreme na init o lamig
naman yun mga matatanda nagkaka bronchitis, pneumonia,
madali din sila tablan kasi nagdedecline na yun respiratory
function nila. Pinapalala pa ng weather condition.
[We have a lot of cases. For example, if the weather is very
hot and humid, the food can spoil immediately causing food
borne diseases. The eldelies have decreased gastric
production that is why they are at high rish to these diseases.
While when we have extreme weather, a lot of respiratory
problems arise such as bronchitis, pneumonia because the
elderlies' respiratory function is already deteriorates due to
 aging. Considering old age puts them at high risk, extreme
weather conditions make them even more at risk]
Respondents 10
“Because of the ano diba unbearable heat or cold we
experience, elderlies are prone to heat strokes or erratic bp
measurement. Syempre mga matatanda yan e, mahina na sila
kasi diba nagde deteriorate na ang kanilang immune system.

[Because of the unbearable heat or cold we experience,

elderlies are prone to heat strokes or erratic bp measurement.
Because they are already old age they are already weak
because there is already a deterioration in their immune
system.]

Respondents 11
Kapag pabago pago kasi ang panahon kawawa naman yun
mga matatanda kasi poor na yun coping mechanisms ng
katawan nila kasi matanda na kaya madali sila maapektuhan.
Kaya usually nagkaka ubo sipon sila then it may lead to
pneumonia.
[When the weather is changing drastically and unstable, the
elderlies are greatly affected because they now have poor
coping mechanisms due to old age that is why they ate at high
risk. The usually get cough and colds that may lead to
pneumonia.]
Theme 2: Lived Experiences. Emergency Department Nurses were asked about their lived
experiences on the adversities of climate change among elderlies through stating the common
scenarios or cases in their department that are brought about by the adversities of climate
change among the elderlies and identifying cases which need most of their attention and action.

5. What are the common scenarios or cases in your department that are brought
about by the adversities of climate change among elderlies?
Respondent 1
Dito sa ER ading ang maraming case e syempre hypertension
yan ang karamihan, tapos heat stroke lalong lalo na ngayon
dahil mainit tapos cardiac arrest.

[Here in ER, the most cases we have is hypertension, and

because of hot weather we also have cases like heat stroke
and cardiac arrest.]
Respondent 2
Tuwing summer, maraming sinsugod dito sa ER na mga
matatanda dahil sa high blood pressure dahil sa sobrang init
na nararansan natin tuwing summer.

[During summer, more elderlies are brought here in the ER

because they experience high blood pressure due to the hot
temperature we usually experience during the summer.]

Respondent 3
Dahil sa extreme heat, it will lead to increased blood pressure
that may lead to a condition called CVA. Another one is yung
sinabi ko kanina yung Pneumonia tsaka Lung disorder

[Because of extreme heat, it will lead to increased blood

pressure that may lead to a condition called CVA. Another one
is what I have said a while ago, the pneumonia and lung
disorders.]

Respondent 4
Ay madaming nagkakasakit tapos sumusugod na mga
matatandang patients naming dito sa ER. Lalo na pag mainit.
Kadalasan mataas yun altapresyon nila. High blood sila.
Tapos yun iba hinihika.

[A lot of people specially the elderly patients are rushed to the

emergency room specially when the weather is very high.
Hypertension is usually the case. The blood pressures of the
patients increase. Some of them are having asthma attacks.]

Respondent 5
Dahil siguro dahil narin sa biglaang pagbabago ng klima
madaming matatanda ang pumupunta dito para magpatingin.
Mostly the common cases here are ano heat stroke at
dehydration talaga. Meron din yung mataas ang bp ganun.

[Because of the drastic change in our climate many elderlies

are coming in the hospital for consult. Mostly the common
cases here are heat stroke and dehydration. There are also
instances where clients have high bp.]
Respondent 6
Kagaya ng sabi ko kanina, hypertension talaga ang maraming
cases dito sa ER lalong lalo na at ang init ng panahon natin
ngayon tska pwede yun maglead to CVA. Hindi mo talaga
maiiwasan yan sa mga matatanda. Tsaka may mga cases din
tulad ng Pneumonia, asthma.

[Just like what I have said earlier. Hypertension is the most

prevalent case here in ER especially If the weather is too hot
and it could lead to CVA. These cases are not avoidable to
elderlies and there are also cases like pneumonia and asthma]

Respondent 7
Usually heat stroke ang pangkaraniwan na case. Dahil nga
dito sa tugue diba masyadong mainit hindi nakakayanan ng
iba. E hindi naman lahat well ventilated at naka aircon ang
bahay.
[ Usually heat stroke is the common case brought here in ER.
As we all know here in Tuguegarao the weather is too hot and
not everyone’s home is well ventilated and have aircon.]
Respondent 8
Siguro yun heat stroke ang usual. Lalo na pag tag init. Madami
sa mga senior natin ang sinusugod dito dahil sa heat stroke.
Lalo na dito satin kasi yun init satin hindi na kaya ng
matatanda e. Tapos may mga hinihika din tayong mga senior.
[ Heat stroke is a usual case specially when the weather is
extremely high. Many elderlies are rushed to the hospital
because they are having heat stroke. Our extremely high
weather cannot be tolerated by the elderlies anymore.
Elderlies also experience asthma ]
Respondents 9
Siguro food borne diseases yun common, tapos yun mga high
blood din madami sinusugod dito kasi tumataas yun bp nila
lalo na pag tag init. Heat stroke usong uso yan. Tapos kapag
malamig naman, mga respiratory problems like asthma,
pneumonia sa mga matatanda."
[Emergencies brought about by borne illnesses are very
common in our department. There are also a lot of patients
with increased high blood pressures going to the emergency
department. Also, heat stroke is also a common case. In cold
seasons, pneumonia and asthma cases are also increasing
among the elderlies.]
Respondents 10
Kagaya ng During the sumer season diba like april and may lot
of elderlies came due to elevated BP or may have sudden lost
of consciousness due to stroke. Yung iba naman e are brought
here due to very high fever and or heat/ stroke.

[Just like during summer season april and may lot of elderlies
came due to elevated BP or may have sudden lost of
consciousness due to stroke. Others are brought to here due
to very high fever and heat or stroke.]
Respondents 11
Ayun common nga yun cough and colds sa mga matatanda,
tapos syempre kapag sobrang init, heat stroke din ang
madalas na cases dito sa emergency room.
[Cough and colds are commin cases among the elderlies. In
extremely high temperatures, heat stroke is usually the case
here in emergency room.]
6. Among the scenarios or cases you provided which needs most your
immediate attention and action?
Respondent 1
Syempre yung nagkakaroon ng sudden cardiac arrest,
kailangan talaga nila ng immediate attention.
[Of course those patients who are experiencing sudden
cardiac arrest, they really need the immediate attention.]

Respondent 2
Yung mga emergency situations like for example yung mga
pasyente na tinatakbo dito e yung mga nakakaranas ng stroke
o cardiac arrest ng dahil sa sobarang init na panahon dito sa
Tuguegarao.

[Emergency situations. Like for example, those patient who

are brought here in the ER are those patient who experience
stroke or cardiac arrest because of the extreme weather here
in Tuguegarao.]

Respondent 3
Dun sa patient na CVA ang case, yung BP niya is elevated so
it needs immediate attention and action kasi it may lead to
 death of a patient which is ayaw naman nating mangyari so we
need to be a competent nurse para hindi ito mangyari.

[To the patient who have a CVA case, which have an elevated
PB so it needs immediate attention and action because it may
lead to death of a patient which is we don’t want to happen so
we need to be a competent nurse so that this will not happen
to our patient.]

Respondent 4
Syempre yun mga na-stroke tsaka inaasthma a. Di ba
sinusunod natin yun ABC. Airway breathing circulation. Pasok
sila dun. Sila ang priority namin sa emergency department.

[Cases like stroke and asthma are the cases we attent to

immediately. We are following the ABC of life which means
Airway, Breathing, Circulation. Asthma and stroke affects
ABC. These should be prioritized in the emergency
department.

Respondent 5
Syempre priority yung daalwa stroke and dehydration. Kasi
diba parehas silang fatal at they both each need prompt care.

[Of course the stroke and the dehydration. Because both of

them are fatal and they both need prompt care.]

Respondent 6

Syempre yung CVA o yung mga patients na matataas ang BP,

kailangan talagang bantayan mo yang mga yan kasi pwedeng
maglead yun sa cardiac arrest.

[CVA and hypertension should be really given attention

because thesecases can lead to cardiac arrest.]

Respondent 7
Kalimitan talaga eh yung mga tao na nahihilo tapos ang taas
taas ng bp. At tsaka syempre yung mga pumupunta dito na
nahihirapan ng huminga diba nga airways ang dapat unahin.
[Usually persons who are dizzy and have high blood pressure
are the ones given prompt attention. And of course the ones
 who have problems with breathing and airway pattern because
airway is the first thing you should give attention. ]
Respondent 8
Priority namin siguro yun patients na may heat stroke tsaka
hinihika kasi airway tsaka circulation ang impaired dun. So
dapat sila yun attendan mo muna bago yun iba.
[Patients having heat stroke and asthma attacks are our
priority because in airway and circulation are impaired in these
cases. We have to attend to these cases first the others]
Respondents 9
Siyempre yun pinaka critical yun heat stroke. Andami na
naming cases na ganyan. Yun mga matatandang vendors jan
sa labas ng palengke yun mga nagtitinda ng gulay exposed
sila sa extreme weather e. Madami sa kanila ang naisugod na
dito kadalasan heat stroke.
[Patients suffering from heat stroke are the most critical. We
have a lot of stroke cases. The elderly street vendors in the
market selling vegetables are exposed to extreme weather. A
lot of them were already rushed here in the emergency room]
Respondents 10
According to my observation sa tingin ko e yung ano heat
stroke has the most cases who needed immediate action.
Heat stroke kasi yung madalas na case nan aha handle
naming.

[According to my observation I think heat stroke has the most

cases who needed immediate action. Because heat stroke has
the most cases that we had handled.]
Respondents 11
“In my day to day experience in the emergency room, the most
prevalent case that have been attended is heat stroke. We are
all aware that because of the changes in our climate we can’t
avoid the prevalence of it especially here in Tuguegarao.”

Theme 3: Role of Emergency Department Nurses. Emergency Department Nurses were

asked about their role in addressing acute healthcare problems of the elderlies brought about by
climate change by articulating their responsibilities and actions needed and the facilitating
factors in delivering a quality health care to the elderlies affected by climate change.

7. What are the responsibilities and actions needed in attending the needs of the
elderlies affected by climate change?
Respondent 1
Syempre ang first naming ginagawa e stabilize namin yung
vital signs nila kung mataas, tapos pag heat stroke naman ang
case e provide ng cool environment sa pasyente and lastly
syempre attend to their needs.

[Of course the first thing we do is we stabilize their vital signs if

they are elevated, and then provide cool environment for the
patient if they experience heat stroke and lastly attend to their
basic needs.]

Respondent 2
Una syempre e mag provide ka ng immediate attention lalong
lalo na kung ang case niye e cardiac arrest tsaka kailangan
din na attentive ka sa pagbigay ng mga needs nila kasi yun
naman tala ang trabaho namin as a nurse at syempre yung
safety ng patient mo dapat parati mong iniisip kasi
accountable ka kung may mangyari sa patient mo.

[Of course the first thing you do is give your immediate

attention in the patient especially if the patient is a cardiac
arrest case and also you should be attentive to the needs of
your patient because that is really our job as a nurse and lastly
the safety of your patient should always be monitored because
you are accountable if something happens to your patient.]

Respondent 3
Being a ER nurse, it is important na ieducate natin yung mga
tao about sa mga prevention ng diseases caused by climate
change kasi it will be a great help sa mga pasyente natin
lalong lalo na sa mga elderlies kasi isa sila sa mga target ng
mga diseases tuwing summer.

[Being an ER nurse, it is important that we educate the people

about how to prevent diseases caused by climate change
because it will be a great help to our patients especially
elderlies because they are one of the targets of diseases
during summer.]

Respondent 4
Syempre we have to give immediate health care. Katulad ng
mga hinihika, mag administer agad ng oxygen tapos
inenebulize yan. Sa mga stroke naman, mag neuro vital signs
 ka tapos oxygen din dapat. Syempre dapat continuous health
education dapat.

[Of course, we have to give immediate health care. For

example if the patient is having astma attack, we have to
administer oxygen and nebulize the patient. For stroke
patients, we do neurovital signs and also administer oxygen.
Health education is also very important.]

Respondent 5
Syempre we have to give immediate health care. Katulad ng
mga hinihika, mag administer agad ng oxygen tapos
inenebulize yan. Sa mga stroke naman, mag neuro vital signs
ka tapos oxygen din dapat. Syempre dapat continuous health
education dapat.

[Of course, we have to give immediate health care. For

example if the patient is having astma attack, we have to
administer oxygen and nebulize the patient. For stroke
patients, we do neurovital signs and also administer oxygen.
Health education is also very important.]

Respondent 6
As a ER nurse kelangan talagang mag health educate lalong
lao na sa mga patient na may history na ng mga sakit katulad
ng hypertension kasi malaking tulong sakanila yun. Minsan
may mga patient naman talaga nakikinig sa mga sinasabi
natin kaya hind naman siguro masasayang yung effort natin
tsaka role naman talaga natin yun as a health care provider.

[As an ER nurse I should really health educate my patient

especially those who have a history of hypertension because
this will be a big help for them. Sometimes there are patients
who listened that’s why there won’t be any effort wasted
because it is really my role as a health care provider.]

Respondent 7
Syempre bilang isand ER nurse dapat alam ko kung ano yung
pinaka kailangan ng patient ko. Dapat alam ko din kung paano
iprioritize ang mga bagay bagay. At tsaka ano dapat I have
gathered a good patient history para alam ko kung anong
kailangan ng patient ko and para makapag deliver ako ng
efficient nursing care.
 [As an ER nurse I should be able to know what the client
needed most, I need to know how to prioritize things. I should
also have a good patient history regarding my patient for me to
be able to know what my client needs and to provide an
efficient nursing care.]
Respondent 8
Sa heat stroke dapat pababain namin yun temperature ni lolo
at lola. Dapat cool lang sila so aapplyan natin sila ng cold
compress diba tsaka syempre oxygenation. Tapos dapat
mapreskuhan yun pakiramdam nila. Tapos sa mga patients na
may asthma attacks naman oxygenation din syempre tapos
idadala na agad sa doctor.
[ for heat stroke patients, we have to lower and cool down the
patient's temperature by applying cold compress and
administer oxygenation. We also have to make them feel
refreshed. For patients having asthma attacks, we have to
administer oxygenation, and refer them to the doctors
immediately]
Respondents 9
Syempre we can reduce the health impacts from climate
change by treating the illnesses and injuries. Approriate
nursing interventions agad agad. Syempre dapat gawin nating
maganda and comfortable yun environment nila pag
inaalagaan natin sila. Tapos kapag may mga disasters katulad
ng bagyo. Pwede tayo tumulong sa pag first aid sakanila lalo
na sa mga matatanda"
[Of course we can reduce the health impacts from climate
chnage by treating the illness and injuries and giving
appropriate nursing interventions immediately. We have to put
the patient in a good and comfortable environment while we
are taking care if them. In times of disasters like typhoons, we
can help in rendering first aid services to those in need
specially the elderlies]
Respondents 10
Importante talaga ang Heath Education like ano always drink a
lot of water, don’t go out under the sun at 10:00 – 3:00 pm,
always bring umbrella or anything to cover yourself or always
drink maintenance medicine regularly. Kasi paano naman nila
maiiwasan kung hindi natin ipapaalam sa kanila diba? (laugh)

[Health education is really important like telling the clients

always drink lots of water, advising them not to go out under
the sun at 10:00 – 3:00 pm and always bring with them
 umbrella or anything to cover themselves or always take their
maintenance medicine. Because how will they be able to avoid
the circumstances if we are not going to educate them, right?]
Respondents 11
“As a nurse the most important thing that I could do is to
educate them by telling them to keep a healthy and balance
meal every day to strengthen their immune system.”

8. What are the facilitating factors that help you deliver a quality nursing care to
the elderlies affected by climate change?
Respondent 1
Unang una ading e immediate response namin as a health
care provider sa case nung patient tapos syempre sa
environment e dito naman sa amin e may aircon tapos
syempre mga medical equipments na kailangan as a basic
support sa emergency case ng patient.

[First is the immediate response of health care provider in the

case of the patient and a cool environment and lastly the
medical equipment needed in the basic support in the
emergency case of the patient]

Respondent 2
Dapat e maayos yung environment mo, dapat properly
ventilated kasi mas magagawa mo ng maayos ang trabaho mo
kung kompartable sa area mo at tsaka dapat din e maluwang
ang ER kasi minsan hindi mo masasabi kung kelan madami
ang pupunta na pasyente sa ER.

[The environment or area should be properly ventilated

because you will do your job effectively if you are comfortable
on your working area and also the area should be spacious
because you cannot predict when and how many patients will
rush to the ER.]

Respondent 3
Health education regarding sa mga nakukuha natin diseases
during tag lamig tsaka summer tapos mga management sa
mga diseases.
 [Health education regarding the diseases we can get during
cold weather and summer and also the management on that
diseases.]

Respondent 4
Siguro yun media katulad ng print outs about taking care of the
patients during extreme weather. Madami ding ganun e.
Syempre nakakatulong din yun cooperation naming mga staff
sa ER. Tulungan kami kung sino mag a assist sa ganitong
case sino sa ganito. May division of labor kami.

[I think media has a great impact in delivering care for the

patients affected by the extreme weather such as print outs.
We have several print outs regarding this matter. Also, the
cooperation within the staff nurses and other members of the
health team in the emergency room is very essential. We take
turns in assisting different cases and ensure that we have
division of labor]

Respondent 5
Siguro yun media katulad ng print outs about taking care of the
patients during extreme weather. Madami ding ganun e.
Syempre nakakatulong din yun cooperation naming mga staff
sa ER. Tulungan kami kung sino mag a assist sa ganitong
case sino sa ganito. May division of labor kami.

[I think media has a great impact in delivering care for the

patients affected by the extreme weather such as print outs.
We have several print outs regarding this matter. Also, the
cooperation within the staff nurses and other members of the
health team in the emergency room is very essential. We take
turns in assisting different cases and ensure that we have
division of labor]

Respondent 6
First syempre is yung environment sa hospital kelangan pag
ER e dapat medyo maluwang kasi may time na halos sabay
sabay na may pumapasok na mga patients dito sa ER, tapos
kelangan din na kompleto ang mga gamit kasi mas
mapapadali yung pagtratrabaho natin at madali lang natin
mabibigay yung mga health needs ng patient natin kung
kumpleto ang facilities.
 [First thing is the environment in the the ER it should be wide
because there are times when patients are coming all at the
same time. The equipments should also be complete to deliver
immediate care and the health needs of our patient.]

Respondent 7
Una diyan e yung pagtutulungan naming mga staff. Tapos
syempre yung mga ginagawa ng government na mga
advertisements regarding sa mga kailangna nilang iwasan
tsaka kailangan nilang gawin para makaiwas sa sakit.
[First thing that really helps is the collaboration between staffs.
And of course the advertisement of government regarding the
things they should avoid and the things they need to do for
them to avoid any kind of diseases.]
Respondent 8
Siguro yun division of labor namin mga staffs sa ER ang
nakakatulong samin. Tulungan lang kami sa pagaattend sa
different cases. Salitan. Tsaka pagiging resourceful din kahit
kulang sa gamit.
[ The division of labor within the staffs of emergency room is
very helpful. We help each other and take turns in attending
different cases. Being resourceful due to lack of facilities is
also important.]
Respondents 9
Minsan trainings nakakatulong din kasi yun sa pag equip sa
mga nurses para makapag diagnose ng tama and ma treat
yun mga new and emerging diseases tsaka para alam namin
kung pano magrespond sa wide range of climate related
health emergencies.
[trainings regarding on how to diagnose and give treatments to
new and emerging diseases are very helpful for the nurses to
be fully equipped in responding to the wide range of climate
related health emergencies]
Respondents 10
“Ano lang e dapat magaling kang kumuha ng history of patient
so that malaman natin what are the interventions and actions
appropriate for the client.”

[ You should be good in taking the patients history so that you

will be able to know the appropriate nursing interventions and
actions appropriate for the client.]
Respondents 11
“Nowadays people are more concern of their health, so by giving
posters through tv ads and continuous health education would be
a big help in delivering a quality nursing care to the elderlies.”

Theme 4: Barriers experienced. Emergency Department nurses were asked about the barriers
they experienced in identifying the adversities of climate change among elderlies by stating the
hindering factors that interrupt them deliver a quality nursing care to the elderlies and their
corresponding recommendations or suggestions to improve the quality nursing care.
9. What are the hindering factors that interrupt you deliver a quality nursing care
to the elderlies affected by climate change?
Respondent 1
Unang una syempre yung malfunctioning or incomplete
equipments ading tapos yung mga hindi available na
medications tapos minsan pag maraming pasyente e kulang
yung mga nurses dito sa ER.

[First is the malfunctioning or incomplete equipments and then

the inavailabilty of medications and lastly if there is many
patients in the area the number of nurses in the ER is
inadequate]

Respondent 2
Siguro yung mga incomplete o sira na mga equipments, kasi
paano ka naman makakapagbigay ng maayos na service kung
kulang kulang naman ang gamit mo sa bawat procedure na
gagawin sa patient mo.

[Maybe the incomplete or defective equipments, because how

can you give a proper service if your supplies is not complete
in every procedure that you do to your patient.]

Respondent 3
In my experience, one factor is non-compliance ng patient for
example is sa mga medicines nila, pag mgaling na sila e hindi
na nila iniinom yung gamot nila which is wrong.

[In my experience, one factor is non-compliance of the patient

for example is in the administration of medication, if their
condition is already okay they will not drink their medication
which is wrong.]

Respondent 4
 Kulang siguro kami sa health education. Kasi sa dami ng
ginagawa mo hindi na namin ma educate yun mga patients e.
Tsaka yun mga patients mismo lalo na yun mga matatanda,
sila pa mismo yun nagrerefuse sa health care kaya
nahihirapan din kami sa kanila.

[Lack of health education may be a hindrance. With the fact

that we have a lot of things to attend to in the emergency
room, we cannot afford or give time to educate the patients
one by one regarding their health related problems. Also,
sometimes, even the patients themselves are the ones
refusing the care being given to them that’s why we nurses are
having a hard time rendering care.]

Respondent 5
Sa tingin ko yung nurse patient ratio.

[I think it’s the nurse patient ratio]

Respondent 6
Mga sirang gamit o di kayay hindi available na mga gamot.
Tsaka minsan hinidi maiiwasan yung hindi pag comply ng mga
patients sa mga sinasabi ng doctor. Tsaka minsan pag
madami masyadong pasyente nagkukulang yung nurses dito
sa ER.

[The hindering factors are dysfunctional materials and

unavailability of medicine. And sometimes the incompliance of
patients to the orders of the doctor and inadequate staff.]

Respondent 7
Yung minsan kasi kulang ang gamit. O di kaya kulang ang
number ng nurse to deliver care. Tapos yung mga patient na
ang titigas ng ulo at hindi marunong umintindi sa pinapagwa
ng nurse.
[Sometimes lack of supplies or the insufficient number of
nurses to deliver care. And some patients are being hard
headed that they don’t comply and cannot understand what
the nurse is trying to tell them.]
Respondent 8
Kulang kami sa nurses compared sa dami ng tao na
sumusugod dito sa ER. Kasi di naman namin mapagsasabay
 sabay lahat e. Tapos kulang din sa gamit syempre aasa lang
naman kami sa pondo gobyerno. Tsaka dahil busy kami, wala
na kami time mag health education sa mga patients.
[ The number of nurses employed is not appropriate and
inadequate compared to the number of patients rushing to the
emergency room. We cannot attend to all cases at the same
time. We also lack in facilities and we only depend on the
funds of the government. Since we are very busy attending to
the needs of the patients, we lack time in health educating the
patients.]
Respondents 9
Siguro kulang kami sa awareness about jan sa climate
change. Na o oversee siguro namin yun effects niya sa health
lalo na sa mga matatanda. Kaya kahit kami rin hindi pa
intergrated yun approach namin mga ganyang emergencies.
Tapos sa dami ng patients kasi coming in and out and cases
dito, di na namin iniintindi yan e.
[we nurses ourselves lack awareness about climate change
and often oversee its effects on health specially on the
elderlies. Thats why our approach is not fully integrated with
such emergenies. And also, with various cases from high
volume of patients coming in and out in the emergency room,
we oftenly ignore such issues like the climate change]
Respondents 10
To many patients in the ER that you can’t health educate
them. Minsan kasi dagsaan hindi mo yun maiiwasan tsaka
ano narin kkulang ng staff.

[To many patients in the ER you can’t health educate them.

Because this events are unevitable and of course the lack of
staff in the are.]

Respondents 11
“We are living in a country that the proper ratio of nurse to
patient is not equal so I can say that understaffed is one of
the factors and the other is barrier in communication because
of different dialects used.”

10. What are your recommendations or suggestions to improve the delivery of

nursing care to the elderlies affected by climate change?
Respondent 1
Dapat sa every health care facility e may complete set of
equipments dahil yun ang makaktulong sa immediate and
reliable response naming sa mga pasyente.

[every health care facility should have a complete set of

equipments because that will help us in the immediate and
reliable response we do in the patient.]

Respondent 2
Dapat e kompleto yung mga supplies na gagamitin sa patient
sa bawat procedure at tsaka dapat appropriate yung number
ng nurses sa number patient kasi mas maayos ang service ng
mga nurses kung kaya nilang ma accomodate yung bawat
patient nila.

[The supplies in every procedure must be complete and there

must be an appropriate division or nurses-patient ration so that
the nurses will properly accommodate every patient in the ER.]

Respondent 3
First we should coordinate sa local government unit para mag
facilitate ng service like health educate the people especially
yung mga elderlies about sa climate change and how this
affect yung health nila at saka how to prevent this conditions.

[first we should coordinate to the local government unit to

facilitate a service to health educate the people especially
elderlies about the climate change and how it affect the health
of the people and how to prevent this condition. ]

Respondent 4
Siguro good communication between the nurses and the
patients. Pati nurses to nurses at staffs. Di ba? Pag
nagkakaintindihan naman lahat yun ang maganda di ba.
Tsaka sana yun facilities ma- improve. Kita mo naman yun ER
natin luma na kulang sa gamit. Though Filipino nurses are
very resourceful okay pa naman.

[I suggest proper and good communication between the

patients and nurses and also within the staffs. Good
 communication leads to better understanding. We also have to
take note of improving the health care facilities. As you can
see, our emergency is old and the facilities are outdated. Good
thing that Filipino nurses are very resourceful that’s why we
can carry on.

Respondent 5
Siguro dapat may tamang ratio ng nurse sa groups ng
patient para makapag health educate din kami para
maiwasan na nila yung effect ng climate change sa health
nila.

[Maybe right ratio of nurse to patient so that we will be able to

health educate them for them to avoid the effect of climate
change in their health.]

Respondent 6
Una dapat makompleto na yung supplies kasi isa yun sa mga
factor minsan kung bakit nadedelay yung kelang gawin dun sa
patients tsaka dapat nagcoconduct ang government ng health
education kasi malaking tulong yun hindi lang sa mga
elderlies.

[In order to improve the delivery of nursing care the supplies

should be complete because this is one of the factors that
delays our nursing care. And the government should conduct
health education because it will be a big help among the
elderlies.]

Respondent 7
Diba as a nurse it is our role to educate our patient. Hindi
dapat tayo mag assume na they know what they’r e doing and
also we should not rely on the advertisements seen on tv. We
should do our part para narin sa ikakbuti ng health condition
ng ating mga patients at para narin hindi tayo mahihirapan sa
pagdeliver ng care sa kanila.
[As a nurse it is our role to educate our patient. We should not
assume that they know already what they are doing and also
we should not rely on the advertisments seen on tv. We should
do our part for the betterment of the health condition of our
patient and for us not to have a difficulty in delivering care to
our patient.]
Respondent 8
Sana mapatupad yun ideal na nurse-patient ratio. Kasi kapag
nangyari yun, mas makakapag focus and attend kami sa lahat
ng needs ng bawat patients di ba mas maaalagaan namin sila
tapos magkakatime na din kami sa ma health educate sila.
[The ideal nurse-patient ration should be implemented. If this
would happen, we could attend and focus to all the needs of
each patient and we could take good care of them better. We
would also have time to health educate the patients. ]
Respondents 9
Health education siguro sa abouth health hazards brought
about by climate change. Teach them, how we can mitigate
and prevent the effects of climate change sa health nila kasi
madalas ang alam nila effects lang sa environment e. And
syempre para ma attend mo lahat ng needs, kelangan
appropriate yun nurse-patient ratio.

[ Health education about the health hazards brought about by

climate change is very essential. Teach them how we can
mitigate and prevent the effects of climate change particularly
to their health because the common notion of the people when
it comes to climate change is that it can only affect the
environment. And of course, to be able to attend to all the
needs of the patients, appropriate nurse-patient relationship
must be implemented.]
Respondents 10
Dapat kahit papano there is a 1:4 RATIO OF NURSE –
PATIENT para lahat taalga ng needs ng patient maibigay at
agad agad silang mabigyan ng care.

[There must be a 1:4 ratio of nurse –patient so that everything

that the patient needed are promptly given and so given
immediate care. ]
Respondent 4

Respondents 11
Through TV ads and flyers discussing climate change and how
to deal with it.
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