Journal of Nursing Science Update
Vol. 11, No. 2, November 2023 e-ISSN: 2829-0003 DOI : http://dx.doi.org/10.21776/ub.jik.2023.011.02.03 p-ISSN: 2829-7075 Website : http://www.jik.ub.ac.id
@JNSU. This is an open access article under the CC BY-NC 4.0 license
125 Original Research
Phenomenology Study of Self Concept And Adaptation of Covid-19 Re-Infection Patient at Work Area of Binong Public Health Care Curug Sub District
Tangerang
Moody Artharini1*, Fitriana Suprapti2, Chatarina Indriati Kusumaningsih3
1Master of Nursing Program, STIKES Sint Carolus
2,3Nursing Study Program, STIKES Sint Carolus
*Corresponding author:
Moody Artharini
Jl. Salemba Raya No. 41 RT 03/RW 05, Paseban, Senin, Kota Jakarta Pusat, Telp: 021-3924094 Email: [email protected]
Article Info ABSTRACT
Article History:
Received 8 February 2023 Revised 23 November 2023 Accepted 28 November 2023
The COVID-19 pandemic and recurrent infections are ongoing worldwide, including Indonesia. Physical issues often occur with fever, nausea, cough, flu, diarrhoea, and body aches. The psychological issues that occur are anxiety, fear of death, worry about losing a job, and stigma from society. Repeated infection with COVID- 19 can cause disturbances in self-concept, including self-identity, self- image, role performance, self-esteem, and adaptation. The study aimed to explore the self-concept and adaptation of patients with recurrent infection with COVID-19 in the work area of the Binong Health Center, Curug District, Tangerang Regency. The research design is descriptive phenomenology, with an in-depth interview technique of 15 participants using the Colaizzi method. The research results in the aspect of self-concept explored four (4) themes, namely 1). Age and gender affect the concern, which uses traditional herbal alternatives. 2) changes in body image do not cause concern, 3).
awareness to limit roles in order to prevent transmission, 4). good self-health can increase self-esteem. The adaptation aspect found that the ability to adapt physically and psychologically speeds up the healing process of the disease. The study concludes that self-concept is not disturbed but feels worried when exposed to COVID-19 again.
In the aspect of adaptation, it finds the need to balance physical, psychological, and spiritual conditions. Recommendations for further research to conduct qualitative research with Focus Group Discussion (FGD) regarding self-concept and adaptation of patients re-infected with COVID-19 for the third time.
Keywords:
Adaptation COVID-19
Recurrent Infections Self-Concept
How to cite this article: Artharini, M., Suprapti, F., & Kusumaningsih, C. I. (2023). Phenomenology Study of Self Concept And Adaptation of Covid-19 Re-Infection Patient at Work Area of Binong Public Health Care Curug Sub District Tangerang. Journal of Nursing Science Update, 11(2), 125–135.
Phenomenology Study of Self Concept …
127 Introduction
Covid-19 is an infectious disease caused by a coronavirus that can cause respiratory tract infections. Coronavirus spreads rapidly in many Asian European countries, Australia, and America (Eastin, 2020). WHO (World Health Organization) on May 19, 2022, there were 590,912,257 confirmed cases of repeated infection (re-infection) Covid-19 deaths of 6,272,408 in 231 countries.
Southeast Asia confirmed 58,047,397 ranked third, after European countries and America (WHO 2022 & Coronavirus Cases, 2022). WHO (World Health Organization) data on May 19, 2022, stated that Indonesia was ranked 19th (Covid-19 et al., 2022). The Covid-19 daily data report in Jabodetabek on February 17 2022 Covid-19 (2022) found 5,030,002 positive cases, 4,414,306 recovered, and 145,828 cases died during the Omicron period (Lapor Covid-19, 2022).
The Omicron variant (B.I.I.529) is included in the variant of concern (VOC), which has increased transmission and higher virulence, causing death (Burhan et al., 2022).
The COVID-19 virus can be transmitted through droplets or fluids of individuals confirmed positive for COVID-19 (Alimansur &
Quyumi, 2020). The virus then forms a new genetic structure after a viral mutation due to transmission (Astuti & Suyanto, 2020).
The incidence of re-infection is not valid when the occurrence of repeated infections of COVID-19 cannot be ascertained when it will occur again in a person. However, the incidence of recurrent infectious diseases of COVID-19 has been increasingly reported (Elzen et al., 2021), and after antibody titers decrease, immunity decreases (Mulder et al., 2021). Recurrent infection with the coronavirus-19 (SARS-Cov-2) often occurs 12 months after infection, indicating that protective immunity cannot last for a long time (Edridge, 2020) and the interval between the first Covid-19 infection and the second Covid-19 infection was an average of 76 days (Wang et al., 2021).
The clinical manifestations of COVID-19 can vary depending on the immunity and ability of the virus to infect (Zang et al., 2020).
Symptoms that arise during repeated infections are fever, cough, fatigue, runny nose, sore throat and headache (Covid-19,
2022). Symptoms of shortness of breath, chest pain, myalgia, arthralgia, diarrhoea, anosmia, rhinitis, dysphonia, sore throat, and symptoms related to the ear, nose and throat (ENT) are symptoms of Covid-19 in the Delta variant that may occur in the Omicron variant (Rosales, 2021 & Nguyen et al., 2022).
Due to the duration of isolation that will be carried out and social restrictions, they cannot gather with the (Chakraborty &
Chatterjee family, 2020). In addition to financial losses due to not working, the patient may experience termination of employment or stigma from the surrounding community (Brooks et al., 2020; Yulianti, 2022). Problems resulting in psychosocial disorders can impact the patient's physical and mental health and well-being (Hossain & Purohit, 2020), so it can interfere with the patient's self-concept and need further adaptation (Galanti & Shaman, 2021).
Runtiko & Santoso (2022), in their research on the self-concept of self-isolated patient participants, concluded that self- concept is different before, during, and after illness. Husein (2021) stated that in his research on the self-concept of COVID-19 survivors, it was concluded that 1) COVID-19 survivors who received support would get a good self-concept and would not limit their interaction with others and 2) COVID-19 survivors receiving stigma lousy behaviour from the referral group will form a low self- concept so that the Covid-19 survivor will limit every interaction with other people.
A healthy self-concept has a high degree of stability, has positive feelings towards oneself and requires adaptation to restore its health status through the Calista RAM sister nursing conceptual model (Roy Adaptation Model). The meta-paradigm concept of RAM (Roy's Adaptation Model) is consistently defined about humans, the environment, nursing, and health (Risnah & Irwan, 2021).
Banten Province has a history of spikes in repeated cases of COVID-19 infection, in fifth position recorded on May 19 2022, reaching 292.83 and 2,930 thousand deaths (databooks, 2022). In the Working Area of the Binong Health Center, Curug District, from December 2020 to May 2022, there were 2855 COVID-19 cases, 320 cases of repeated COVID- 19 infections, 2565 patients recovered, and 44
Phenomenology Study of Self Concept …
128 deaths. The researchers were interested in exploring more deeply the self-concept and adaptation of patients who experienced repeated infections of COVID-19 in the working area of the Binong public health care Curug sub-district Tangerang.
Method
The type of research design is qualitative research with a phenomenological approach. (transcendent phenomenology).
The total number of participants was 15 people (N= 15). The tools used in this study include a 2-sheet interview guide (attachment 5), field notes I sheet (attachment 6), and a mobile phone as an audio recorder from a Samsung SM-J810Y/DS cellphone. The interpretation of data analysis in this study was made based on the results of the coding of the verbatim interviews of all participants.
Questions asked include:
1. The aspect of self-concept: Sub-theme of self-identity
a. Please explain how, in terms of identity- based on your age, when you have a repeated infection with Covid-19.
b. Please explain how, from the aspects of identity-based on your gender, when you experience a repeated infection with Covid-19.
c. Please explain how, from an identity aspect, based on your culture, you experience repeated COVID-19 infections.
2. The aspect of self-concept: sub-theme of body Image.
3. Please explain how you would describe your physical condition when you experienced the second COVID-19 self- isolation (weight, thinning hair, hair loss, acne, and skin discolouration).
4. The aspect of self-concept: sub-theme of Role performance.
5. Please tell yourself about how you carried out your role, both in the family and in society, while you were experiencing repeated infections with Covid-19.
6. The aspect of self-concept: the sub-theme of self–esteem.
7. Please explain how your self-esteem and your hopes are when you experience a second recurrent COVID-19 infection.
8. Adaptation aspect. Please describe how you adjusted both physically and psychologically when you experienced repeated COVID-19 infection during independent isolation.
Results and Discussion Age Distribution
The age distribution found in this study was between the ages of 20-60 with a mean of 40 years, and the highest age frequency was found in the characteristic frequency of 41-60 years with a percentage of 53%. The participants' age characteristics align with the research of Cavanaugh et al. (2021), who found that the age of patients with repeated COVID-19 infections was more common in the 18 – 59-year age group. Hu et al. (2021) found something similar: those aged 0-24 years had a lower incidence rate than those aged over ± 25-65.
Miller (2011) found that the cause of the high incidence of recurrent infections at the above age was due to the increasing age of the patient; the immune cells would experience a drastic shortening of human lymphocyte cells so that it could cause interference with the immune system. This study is supported by Zhao et al. (2022), who states that the ageing process causes a profound restructuring of the immune system, generally leading to body protection against infection (COVID-19) and cancer.
The age range of patients with repeated infections above is not in line with Slezak et al.
(2021) that the severity of COVID-19 repeated infections was found to be dominant in the 18- 39year age range as many as 31697 (42.2%).
The research of Bastard et al. (2022) found that most patients with COVID-19 had repeated infections at 18-40 years old.
Another difference was also found by Arafkas et al. (2021), who found that patients with repeated COVID-19 infections also occurred at an average age of 65.4 years with ages 19-91 years.
Based on data from the Ministry of Health (Covid-19 emerging dashboard infections) dated October 3, 2022 (2022), it was found that the highest age of patients with Covid-19 infection was found to be at the age of 25-34 years, namely 10.7% of the total.
Phenomenology Study of Self Concept …
129 From some of the differences in the findings above, there is justification for the study of Spicer et al. (2022), which found that in individuals aged ± 60 years experiencing decreased protection compared to those aged between 20-59 years, natural infection provided substantial and persistent immunological protection within a certain period.
Table 1. Age Distribution Time span
(years old) Freq Percentage % 20 - 30
31 - 40 41 - 60
3 4 8
20%
27% 53%
Gender Distribution
The gender of participants who experienced repeated COVID-19 infections in this study was found to be more experienced by women, namely 13 people, with a percentage of 87%. Research conducted by Philz et al. (2021) on repeated infections of COVID-19 in Austria stated that data from patients with re-infection, as many as 40 more cases occurred with 25 female patients (62.5%) and 15 men (37.5%). The results of the study are in line with Cavanaugh et al.
(2021) that patients with repeated Covid-19 infections occur primarily in women, as evidenced by a total of 246 patients, there are 146 (59.3%) women and 100 (40.7%).
The reason that the pandemic can affect the male and female populations in different ways is that depression and inflammation significantly affect mental health, especially in women, so it is easy to experience a decrease in body resistance and repeated COVID-19 infections (Bucciarelli et al., 2021). In Riau province, it was found that out of 122,497 COVID-19 cases, 51.3% were women (Sukirman et al., 2021).
The study's results study's results are not in line with Satria et al. (2021), who found that the highest number of COVID-19 sufferers was male, with a percentage of 60.6%.
Supporting research was carried out by Cen et al. (2020), who found that most of the patients with COVID-19 were male because most of the male patients had a history of smoking. Bauer et al. (2013) explained that cigarette smoke significantly affects the immune system, reducing the body's ability (the host) to
increase the appropriate immune and inflammatory response to microbial agents, namely interferon type 1 and interleukin 1 signalling in the respiratory tract.
Based on data from the Ministry of Health (Covid-19 emerging dashboard infection) (2022), it was found that the highest gender of Covid-19 sufferers was found to be most common in women with a percentage of 50.4% and men 47.6%, while 2% was unknown. From some of the differences in the findings above, there is justification in the research of Bastar et al. (2021), which found that repeated infections of COVID-19 were more common in women than men and Slezaak et al. (2021), which also supports the high likelihood that patients will occur in women.
Table 2. Gender Distribution
Gender Amount %
Female
Male 13
2 87 %
13 % Distribution of Work
In the demographic data, the occupations of research participants varied, with the highest percentage occurring in health workers (doctors, midwives, nurses, ambulance drivers, and hospital administration officers), with 47%. This finding aligns with Lan et al.'s (2020) research on 103 workers, which found that the five occupational groups with the highest cases of repeated COVID-19 infections were health workers (22%), drivers and transportation workers (18%), and service and sales workers. (18%), cleaning and household workers (9%) and public safety workers (7%).
Health workers have the highest number of COVID-19 infections, according to Johnson et al. (2021), because medical officers often make direct contact with patients and families of patients infected with COVID-19. A similar study by Byrne et al. (2021) found that health workers experienced an increased workload during the pandemic, causing fatigue and impacting mental health. This condition causes a decrease in body resistance and is susceptible to disease, especially exposure to Covid-19.
Phenomenology Study of Self Concept …
130 The results of the study are not in line with Keliki & Sari (2022), who found jobs that have a high risk of a high incidence of COVID- 19 infection are traders/entrepreneurs with a percentage of 39.3%, which is because the work allows someone to meet or make contact with people infected with Covid -19. Widjaja et al. (2021) found that the highest risk of contracting COVID-19 infection was among non-health workers, with a percentage of 91.7%.
From some of the differences in the findings above, there is justification for the research of Hiironen et al. (2022) that jobs in the health, social, hospitality, restaurant (cafe and pub) fields, warehouse management, construction, and education are jobs that are associated with the possibility of be a Covid-19 case. By the conclusion of the Ministry of Health HK.01/07/MENKES/327/2020, it has been determined that the types of work that are closely related to exposure to Covid-19 are health workers who serve Covid-19 patients, laboratory health workers, non-health workers in health facilities who have contact with Covid-19 patients (delivering patients, cleaning rooms in patient care areas, health workers who perform duties outside the health facilities area, tracing officers, ambulance officers, mortuary officers) so that they require serious attention.
Table 3. Distribution of Work Work Amount Percentage
%
• Health workers (doctors, midwives, nurses, ambulance drivers, hospital administration officers)
• Service and Sales Workers (Priests, Teachers, employees, and bakers)
• Housewife
• Student
7
5
2 1
47%
33%
13%
7%
Distribution of Covid-19 Time Range The distribution of diagnosed time spans of early COVID-19 and repeated infections of
COVID-19 occurred at a frequency of 11-15 months. There were five comorbid participants with comorbid criteria, including hypertension, diabetes mellitus, asthma, and obesity. These data align with Endrige's research (2020) that the earliest time for re- infection by seasonal coronaviruses is six months. It often occurs at 12 months when protective immunity is insufficient so that protective immunity is not in the long term.
Recurrent infection with COVID-19 is estimated to appear 80% after six months after infection (Ferdinands, 2022).
The time span of repeated infections is not in line with the findings of Machzuma (2021) that repeated infections can occur after more than 90 days of being cured of the first infection. Wang et al. (2021) in Asia, Europe, North America and South America found an average interval between the first Covid-19 infection and the second Covid-19 infection, an average of 76 days. Another study conducted by Pinto et al. (2021) reported the characteristics of the time span of repeated infections, which were found to report 27 cases of re-infection with COVID-19, the duration between the first and second episodes was 108 days with a median of 60 days while Euser (2022) found eight weeks (2 months) between two positive PCRs can be defined for Covid-19 re-infection (Euser, 2022). Re-infection of SARS-Cov-2 is thought to occur after antibody titers decrease (Mulder et al., 2021). COVID-19 infection can protect the body and form antibodies that can last eight months or even longer, especially for people who are infected with severe symptoms, and the vaccine can protect the body for ± 6 months (Linda, 2022). According to the PAPDI regulation (2021), if a COVID-19 survivor has recovered for at least three months, it is appropriate to be given the COVID-19 vaccine. Patients who have been infected and receive the first dose experience significant symptoms, namely reactogenesis, which describes the short-term reaction of a system to the vaccine and the immune response at the first dose of CD4 T cells is frail, resulting in repeated infection with Covid-10 (Joseph et al., 2021).
Phenomenology Study of Self Concept …
131 Alfatihah et al. (2021) concluded that previously infected patients tend to have weak CD4 and CD8 T cells after vaccine administration, which is caused by CD8 cytotoxic cells that do not work specifically with Helper T cells; factors that appear to cause recurrent infections, such as in elderly, congenital diseases, viral mutations, and number of vaccine doses. Anti-spike immunoglobulin G (IgG), IgA antibodies, and spike-specific T cells could be detected on day ten after the initial COVID-19 vaccine was given. However, most were not detectable, indicating that binding antibodies and T-cell responses are responsible for protection against COVID-19 infection (Kalimuddin et al., 2021).
Table 4. Distribution Of Covid- 19 Time Range
Time Range Amount % 11-15 month
06-10 month 01-05 month
12 2 1
80%
13% 7%
Clinical Manifestations of Repeated Infection With Covid-19
Of the overall clinical manifestations of participants in this study, it was found that the highest clinical manifestation experienced by participants was fever with nasal congestion as much as 53.3%. This finding is in line with the results of a study conducted by Susilo et al.
(2022) that the majority of patients with repeated infection with Covid-19 had mild symptoms or even asymptomatic clinical symptoms in patients with the Omicron Covid- 19 variant, which was considered not as severe as the previous variant, especially in patients with the Omicron variant of Covid-19.
Covid-19 Delta variant. Research in line with Brief (2021) in the European Center for Disease Prevention and Control found that patients with repeated infections can experience the same spectrum of complaints from the previous COVID-19, ranging from asymptomatic to severe. Research not in line with Lippi et al. (2022) found that the seven most common symptoms experienced by COVID-19 patients in the Omicron variant were conjunctivitis, chills, cough, pain, fever,
nausea and sore throat. The findings of Maisa et al. (2022) found that most of the cases were symptomatic (89%). They most reported mild symptoms, which are asthenia (fatigue), cough, fever, headache, myalgia, sore throat, flu and flu symptoms such as loss of smell (8.9%) and taste (9%).
Carlotti et al. (2020) stated that people infected with SARS-Cov-2 will go through the replication stage for the initial few days followed by the adaptive immune stage over the next few days. At the replication stage, the virus reproduces itself, causing symptoms of influenza and fever characterized by mild symptoms due to the virus's direct symptomatic effect in the adaptive immune stage. Viral levels decrease as the immune system takes over, but a storm of inflammatory cytokines causes tissue damage, and clinical deterioration can occur. Another conclusion is that the primary mode of transmission of this disease is through tiny droplets when sneezing; many who have been identified as having repeated COVID-19 infections only experience mild symptoms such as mild cough or do not complain of pain, which until now, experts are still investigating determine the transmission period or incubation period of Covid-19 (Kemenkes RI, 2022).
Table 5. Clinical Manifestations of Repeated Infection With Covid-19
Clinical
manifestation Amount Percentage
% Stuffy nose fever
Sore Throat fever Asymptomatic
Fever Suffocating
8 6 2 1
53.3%
13.3% 40%
6.6%
Thematic Analysis Result
The interpretation of Collaizzi data analysis in this study was made based on the results of the coding of the verbatim interviews of all participants. The findings of this study are divided into two aspects, namely aspects of self-concept (self-identity, body image, role performance and self-esteem) and aspects of adaptation, which can be concluded as follows:
1. Regarding self-identity, 2 (two) themes
Phenomenology Study of Self Concept …
132 were explored, consisting of sub-themes 1.
COVID-19 still raises concerns for all ages and genders, 2. The alternative method chosen is traditional herbal medicine.
This theme was chosen because there was an increase in participants' concerns regardless of age and gender.
2. In the body image aspect, the theme is explored that changes in body image do not cause concern.
The definition of a change in body image that does not cause concern is the occurrence of physical changes in patients when experiencing repeated COVID-19 infections, which are characterized by weight gain, weight loss, hair loss and changes in skin colour slightly darker but do not cause excessive feelings of worry in individuals because they are while those that are only experienced as long as health is disturbed due to repeated Covid-19 infections. The results of the study were found from the answers of 15 participants from statements describing changes in their physical body image when experiencing repeated COVID-19 infections with the keywords: Weight gain; obesity, weight loss, hair loss, and dark skin.
3. In the aspect of role performance, the theme of realizing the limited role caused by COVID-19 was explored
The definition of awareness of limiting roles to prevent transmission is an action taken by individuals based on self-awareness and knowledge of the recurrent infectious diseases they experience so that they show through behaviour to limit themselves from their social scope, including their work, so that disease transmission does not occur. The results of the awareness theme limiting the role for the sake of preventing transmission is the answer to the question of the role performance aspect, which produces 15 keywords: whether you want to or not to keep playing the role, unable to carry out the role optimally, role disruption, limitations, cannot be maximized, changing attitudes, self-isolation, not allowed to work, Covid status must rest, cannot go anywhere, must be sent home, hampers carrying out roles, roles are replaced, others assist work, difficult to find needs, and cannot work.
4. Regarding self-esteem, the COVID-19 theme
was explored, resulting in low self-esteem and positive expectations after exposure to COVID- 19. The results of the fourth theme (four) that good self-health increases self-esteem are obtained from 2 aspects: self-esteem when experiencing repeated infections and self- expectations. The form of expression in the aspect of self-esteem resulted in 6 keywords:
shame, low self-esteem, lack of confidence, inferiority, fear, and self-denial.
5. In the adaptation aspect, the theme is explored, namely the ability to adapt physically, psychologically, and spiritually to accelerate the healing process of disease.
The results of the theme of being able to adapt to speed up the healing process of the disease were obtained based on the participants' statements through physical, spiritual, and psychological adaptations. The participant gave an example: When I am at home, I get rid of my boredom by watching television and YouTube, exercising at home, having regular nights, sunbathing, diligently taking medicines given by the doctor, and drinking herbal.
Conclusion
Recurrent infection with COVID-19 can occur in someone even though they have received the first vaccination, the second vaccination, and even a booster vaccination.
Signs and symptoms of repeated infection with Covid-19 tend to be milder even without symptoms. Aspects of self-concept are not disrupted, but they are worried if a recurrence of Covid-19 occurs. The aspect of adaptation, apart from the physical and psychological aspects, is through spiritual adaptation. To meet their needs holistically.
Limitations of the study
In this phenomenological research, data collected did not get non-verbal expressions because it was carried out during a pandemic which required the use of health protocols.
Acknowledgement
The author would like to thank the lecturers of the Sint Carolus High School of Health Sciences, Mrs. Justina P Acihayati, M.Kep.,Sp.Mat, DNSc., Mrs. Dr. Fitriana
Suprapti, MAN,. Mrs.
Ns.Ch.IndriatiK.,M.Kep.,SpKep Kom.,DNDc,
Phenomenology Study of Self Concept …
133 Mrs. Dewi Prabawati, Head of Tangerang Banten District Health Office Mrs. dr.Hj.
Desriana Dinardianti MARS, Head Health Center of Binong Curug drg. Nova Widasari, and all parties involved in completing the research process.
Conflict of Interest
The authors declare no conflict of interest.
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