Official Thesis Sept 4 13

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING
Chapter I
Background of the Study We most likely to have a perfect job the course we have finished People are expecting to become someone financially stable at something hes good at or to gain and achieved a future dream after he graduates from college and become professional. Although, jobs available for nurses are eventually falling down, student, student nurse strive themselves to put an end to what they have started. Looking at the current situation, student nurses have fears and doubts for what to become of them after passing the nursing board exam. Will there be available jobs for me in the hospital? In clinic? Or even in our Local community? Will I actually get a proper job for my licensed career? Or should I take a different path to earn and be able to somehow survive in this world? These questions lingers and continuously hunts the minds of the future and while on that, people tend to change their path and detour to a more comfortable road. Philippines do produce thousands of nurses who became registered nurses within a year, but jobs provided for them by the government continuously depleted which take effects on an individual to grab a different job for various reasons. Recent reports put the number of new nursing graduates at 40,000. However, nursing unemployment is
rising because of the surplus in supply. Hospitals are full and nurses dont know where to go. In addition to that, emotional effect is also a thing to be explored by the researchers. Dreams, future aspirations, family-related issues, spiritual faith and financial aspects are factors that researchers would like to focus hence, be able to acquire and access through an individuals point of view. The researchers seek connection with the respondents and gain more understanding with their capable minds to interpret the reasons behind the possibilities of being a jobless graduate nurses or a professional nurse in the future. If you are a nurse who recently took the board exam, then you must be one of the many new graduates who are considered to be unemployed. After the long weekend parties, holidays, and vacation trips a month ago, you should have recently wondered 'hey what's next for me now?' Well you are not alone. In fact, many of my review mates in a local review center headed to many local BPO companies here in our city. BPO or business process outsourcing involves the contracting of the operations and responsibilities of specific business functions (or processes) to a third-party service provider. Employees who work under these companies are referred as call center agents or customer service representatives. Any graduates here in
the Philippines has once in a while heard things related to call center companies, etc. Undergraduates, unemployed graduates of nursing almost exclusively resort working for these companies. Armed with your English language literacy, this work will not need so much of your math skills nor theoretically inclined whatsoever which are related to your degree. If you have been very comfortable using the language then you should be fine with it. Nurses who have been very dedicated to their fields is left with no choice but to work for companies that give them a good offer. Nurses too are very capable of working in these BPO companies as well. Nurses are trained to work under pressure. They accomplish the job completely and right on time. Almost every graduate nurse who finished the degree is equipped with good language skills. We have refined interpersonal relations to different people. People-friendly that is disciplined with strong working ethics. Nurses are also expected to stay awake all night due to our ever dynamic shifts. Nurses are prepared to take any job that apprehends any time-changing working hours. Thus only indicates why nurses are good fit for such job. And that is why also many call center companies welcome theses manpower with open arms. Another point to raise would be: Nurses studied for a BSN degree for 4 excruciating yearswhy then work for BPO companies? Any
nursing student's parents and kind relatives exhausted around Php 500,000,00 700,000,00 to finish their course, work as a nurse, and go abroad . They did not spend amount of money just to end up sitting on a swivel chair in a front of computer with the headset on. Indeed, to work as nurse, one should need to finish the degree. Versus to work as a call center agent, it only need 4 semesters of any course in college which able you to get the work. But still, it is
considered to be underemployed since being a Call Center agent is not in line with the degree you earned. Perhaps you will still be included in the DOLE statistics Meager Wage of hospitals (6-10K) VS the enticing 10-18k old BPO companies. Non-contractual (for staff nurses) VS Contractual BPO companies. And to sum this up, you question yourself 'Isn't it such an opportunity to waste?'. This issue is truly a reflection of our economys poor condition. The surplus of manpower in our country has lead to the emergence of temporary contractual employment wherein workers are very vulnerable to any possible exploitation. Still, graduate nurses who decides to work off the track for these companies are not be blamed. A decision as to be made and its for the benefit of their families and for personal growth as well.
Researcher's Background Our group is composed of six (6) nursing students- four females and two males -all in their Fourth Year Level in Wesleyan UniversityPhilippines, each having unique characteristics in pursuing this research study.
Biases We have varied perceptions regarding Call Center Agents. Three of our members believed it is the first job they can give a go after graduating if they won't be able find a nursing job. Two of us where ascertained that they have known graduate nurses who became Call Center Agents that makes a living twice or even thrice as what nurses do. The last one thought that shifting to a different job which offers a higher salary would let them get stuck in it for a long period of time, resulting to eventual loss of knowledge and skill they gained as nursing students. All of us agreed that being a Call Center Agent is a good job but a really tough one but convinced that it is not as tough as being a nurse. The idea of a job-on-the-spot that can let graduate nurses grab. We also claim that working in Call Centers will let us explore more of the world before settling down as a nurse. All of us agreed that despite of our diversity in opinions and perceptions, we exclude our biases in understanding and knowing the life and experiences of being a Call
Center Agent.
Experiences Some members experienced being asked or recruited to join but they refused to. They were afraid that it will hinder their studies. One member, has been acquainted to a Call Center Agent and helped to seek job hunters. Another member had a fellow nursing student who after graduating entered and became a Call Center Agent. Considering these, we conduct a group discussion. We brainstormed this topic and unanimously agreed to it to be our research topic.
Strengths We applied other components of therapeutic relationship such as active listening, acceptance, genuine interest and positive regard during interaction process to facilitate cooperation from our participants and obtain the information we needed. We divided the tasks accordingly and all were willing to move beyond our comfort zone in fulfilling our duties. In addition, we encouraged maximum participation where options and ideas are openly discussed and decided upon. We did critiques in each others work for improvement and respected what each of us would like to share. Barring all circumstances of disagreement, these disparities were properly received.
Limitations In as much as we were neophytes in conducting interviews and doing qualitative research, we have certain limitations. Admittedly, our working knowledge in the conduct of interview and phenomenological study was inadequate. Nonetheless, we admitted that this research required our extra effort and sacrifice. In order to overcome such constraints, we started applying communication techniques we had learned on our Psychiatric Nursing to enhance our interviewing skills. We read book about Qualitative Phenomenology and Call Center Agents. We also become more attentive during discussion of research. We also did lots of observation, research and expert interview regarding this topic.
Statement of the Problem Generally, this study wants to aim to describe, explore and explain the Lived Experiences of Call Center Agents. This study wants to answer the following: 1. What are the lived experiences of call center agents who were
nurses by profession? 2. How do there experiences affect the different aspects of their lives?
Assumptions of the Study 1. Researchers assume that challenges and problems encountered by the respondents has greatly affected their physiological, social,
psychologically, emotionally and spirituality aspect of their lives. But with the among and hardworking personality of graduate nurses, they managed to resolve every dilemma that comes to their way. 2. The researchers presume that the respondents would be likely to shift their job to a nursing profession whenever the opportunity comes in.
Significance of the Study To the Readers. This study would promote awareness and provide them further information about the experience of Call Center Agents. Thus, enliven their interest in getting more involved with the study. To the Nursing Students. This would be a significant tool for them in opening their minds to some short coming that they have made along their duty as students nurses. This study will aid them to see the side of their patient to what else should be improved to the kind of health services they give. To the Participants. This particular study could be significant to our respondents for the main reasons that they were recipients of our improved services. To the Participants. This study gives the participants sense of
knowledge or perceptions about their personal point of view of their profession and their current job as a Call Center agent. They start to realize how these experiences change or affect physiologically,
emotionally, socially, psychologically and spiritually in positive and negative ways. To the Nursing Researcher. Findings of this study could be a reference material for future research and may play a significant role since it is a description of evidence used in supporting nursing practice.
Furthermore, it could help to justify and develop the quality of the research as well as identifying recent updated information related to call center agents. To the Society. This study may help other to understand the different experience of a Call Center Agents by means of communicating and sharing their lived experience. By interacting with them they would know each other and be able to understand the attitude and feeling of both sides. In this process, they will prevent pre- judgment and learn to understand and respect their chosen occupation. In this sense, they would accept they differences. To the Community. This study may provide additional insights on the experiences of Call Center Agents. After all, one of the core values of nursing is commitment to the community providing the best nursing care and health education.
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Delimitations and Limitations of the Study The purpose of this study was to define, explain, and explore the lived experiences of call center agents. The researchers use qualitativephenomenological approach. Purposive sampling technique was utilize. Five Call Center Agents were interviewed in order to have an in-depth understanding of their lived experiences. This study was conducted from June to September 2013.
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Chapter II
Foreign Literature Nurse researchers need to explore study abroad programs and identify their impact on the development of cultural competence and global perspectives in nursing students. Despite the anecdotal
professional and personal benefits that have been attributed to study abroad in other disciplines, current nursing literature regarding this topic is limited and has only emerged in nursing research within the last decade. There is a significant gap in the existing body of knowledge with respect to American nursing students who study abroad and the reported benefits of and impediments to their experiences. Much of the nursing research conducted with American nursing students has been quantitative as opposed to qualitative studies with European and Australian nursing students. Many samples are homogenous and therefore exclude diverse populations. Further research involving all methodological designs is warranted to better understand this type of engaged learning. Not only Filipino domestic helpers, but even Filipino nurses and other health workers are prone to recruitment abuses, the International Labor Organization (ILO) reported yesterday. Citing recent studies, ILO said skilled and educated foreign
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healthcare workers, including Filipinos, are vulnerable to recruitment violations. While going through the recruitment process, foreign nurses experienced modification of contracts without their consent, withholding of contracts as well as other immigration documents by recruiters, the ILO noted. ILO said many foreign healthcare workers are not familiar with the positions they were recruited for and their alien workplace prior to arriving at their destination. According to the ILO, demand for registered Filipino nurses has been increasing since 1997, with the highest deployment recorded in 2011. With the recent decline in the recruitment of Filipino healthcare professionals in Europe and North America, the deployment had shifted in recent years to countries in the Middle East. The Philippine government reported an average of 12,000 Filipino nurses leaving the country annually to seek employment with higher wages. While migrant healthcare workers from developing countries are contributing to the healthcare sector of developed countries, ILO said the migration of professionals and skilled workers from developing countries has negatively affected the development potentials of the countries of origin. ILO said the phenomenon called brain drain of highly skilled nurses and even doctors who opted to work as nurses abroad had been observed in the past decade.
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The migration of healthcare professionals had an impact on the achievement of health-related Millennium Development Goals (MDGs), which relies on the national healthcare system built on sufficient, quality and competent health professionals. To address the problem, the ILO, with $3-million funding support from the European Union, is implementing a program called Promoting Decent Work Across Borders: A Project for Migrant Health Professionals and Skilled Workers. ILO said the project seeks to better understand schemes in line with circular migration of health professionals. With the project, ILO hopes to promote approaches to migration that benefit the migrant workers, the source and destination countries within a rights-based framework for better labor migration management. The project focuses its activities on three Asian countries with significant outflows of health professionals and skilled workers the Philippines, India and Vietnam. Philippine Literature With the Business Process Outsourcing (BPO) industry
encountering problems of high attrition rates, it is critical to explore ways to ensure employee retention. One approach is by developing positive work relationships.
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How can this be achieved in the workplace? Organization Psychology literature emphasizes that organizations benefit when employees experience positive interpersonal relationships in the workplace. These relationships are the key for effective job performance. Relationships like these provide social support and criterion for effective job performance. One important factor that influences the quality of workplace relationship is the employees willingness to self-disclose. Self-disclosure is revealing any information about ones self that is unlikely to be discovered from other sources. One discloses to let authenticity enter into a social relationship, which is also linked to our well-being and selfconcept development. The nature of work in the fast growing contact call centers (the biggest sector within the BPO industry) industry is characterized by demanding and dynamic work shifts. Thus, there is moderate time spent on socializing with co-employees. However, the potential benefits of selfdisclosure cannot be ignored. According to a study conducted by Jamandre and Arce (2011) among 100 Filipino customer service representatives (CSRs), et al., selfdisclosing promotes high morale. When morale is high, employees approach their work with energy, enthusiasm and increased willingness. They are enthusiastic about work once they get there. Increasing
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morale makes good business sense. High morale in a contact center environment can lead to less job-related stress, increased job
satisfaction, higher productivity, reduced absenteeism and higher ownership of customer concerns. It may eventually result in high customer satisfaction. Findings suggest that the CSRs are more likely to disclose to their co-CSRs and immediate supervisors information on tastes and interest, as well as work and attitude more, than they did on topics about body, personality and money. Furthermore, the CSRs are more likely to disclose to their co-CSRs in general than in full details; and are more likely to not disclose to their immediate supervisors. CSRs tend not to disclose during the first few months of their relationship. This may be due to Filipinos concept of hiya. In the Filipino culture, peer group acceptance is considered important to ones professional and occupational growth. Our concept of hiya defines how we behave in public and in relation to others. Thus, familiarity and confidence is essential. Confidence is the key to self disclosure. Revealing ones self occurs not until one knows the attitudes and beliefs of ones co-employees. Thus it takes time to reveal ones self. Self-disclosure helps develop trust among employees and the feeling of belongingness in a group. Literature tells us that this positive
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perception of the organization and the people that they work with enhances the employees desire to stay. Aside from benefits mentioned earlier, self disclosure may mean lower attrition rates. Since positive relationships are enhanced, thinking of moving out to another company may be lessened because employees are happy and would want to still be with the people they work with. To facilitate self-disclosure, organizations may provide periodic team building activities and seminars that can enrich the interpersonal relationship among their employees. They can also provide a friendlier workplace where employees can interact more and allow them to be confident in sharing themselves with their work mates. Foreign Studies Despite the anxiety of handing over call center operations to a third-party outsourcer, organizations are still quietly off-loading their customer support efforts. And in spite of cultural, technology, and proximity issues, there is a significant movement toward overseas outsourcing. The call center outsourcing industry has become big
business, according to Frost & Sullivan. It says the outsourced call center industry reached $22 billion in 2002, and projects the industry to climb to $25.7 billion by 2009. "More companies are looking to outsource their call center operations as they realize that in most cases, they are not core to their business," says Robin Goad, a managing
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analyst at Data monitor. While today's biggest brands, from Time Warner Inc. to Hershey Foods to The Wall Street Journal, rely heavily on outsourcing to deliver around-the-clock service, few companies readily admit it. They want to give the impression they are always ready to field questions and take orders, but most can't justify the expense of supporting their own call centers at all hours. Instead, they outsource some or all of their call center activities. "There may be a small number of orders coming in, but you don't want to miss that call, so outsourcing makes good economic sense," Barry says. These companies are often reluctant at first, outsourcing just a small part of their overall call center activities. Most catalog businesses, for instance, may outsource just 5 percent to 15 percent of their transactions, using outsourcing for call overflow during the peak hours and for after-hours and weekends. But if the job is done well, companies often expand the contract to additional parts of their businesses or renew their existing contracts. Triton PCS, in Berwyn, PA, which provides wireless communications services to 860,000 subscribers in the southeastern U.S., outsources its call center operations with Convergys during high-volume calling periods, citing the company's ability to apply its service standards and criteria to its PCS customers. DIRECTV, a digital television service provider, extended its alliance with Convergys for another three years, through 2006. "Convergys has done an excellent job supporting the rapid growth of our
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business over the past nine years," says Bob Meyers, executive vice president of customer satisfaction for DIRECTV, a division of Hughes Electronics. "Our number one customer satisfaction ranking in the J.D. Power 2002 Cable/Satellite TV Customer Satisfaction Study, as well as our top rating in the American Customer Satisfaction Index for the second consecutive year, reflects the excellent job Convergys is doing for us." There is also the Crossing The Offshore Chasm. Cincinnati-based Convergys, like many outsourcing providers, has offshore operations in India and the Philippines, along with five additional global locations. Aside from DIRECTV, its call center outsourcing clients include Comcast, Triton PCS, and Cox Communications. The most common concerns raised by customers used to be the system and technology barriers, as well as cultural barriers, particularly anxiety over language differences. But lower labor cost was always the intrigue, says Dennis Ross, general manager of offshore operations at Convergys. Regarding technology concerns, Ross says, "Our international private lease circuits all deploy the same technology. If a call needs to be handled in India, the Philippines, or Omaha, we are ready with one platform and one set of software." To address cultural concerns, Ross encourages clients to visit Convergys' offshore call centers. "Once they see the operations, talk to agents on the floor, and meet with the management team--that quickly seems to bridge the gap in terms of cultural differences." Getting
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companies comfortable with the culture is a crucial hurdle, Barry says. For retail companies like Nordstrom, serving the customer is not just taking the call and processing an order, it is providing a positive buying experience. Customers of high-end retailers have come to expect a higher level of handholding, with call center reps offering gift suggestions and detailed product information. Other companies, like Dell Computer and Crutchfield, need to have personnel to handle technical questions about complex products. For that reason, Convergys hires college graduates seeking long-term career opportunities, not temporary workers. "The reps we hire range from simple sales and support staff up to the technology bits-and-bytes crowd to level-three hardware and software personnel," Ross says. One of the most challenging aspects of offshore outsourcing is getting reps to understand American slang. Typically used American phrases like out here in the sticks and strip malls can confuse even the best-educated telephone rep, so outsourcing companies must spend large chunks of time on role playing exercises. Venkat Tadanki, founder and vice president of sales and marketing at Daksh, a call center outsourcing firm based in Haryana, India, says India has the secondlargest number of English-speaking graduates next to the United States. All 1,700 of Daksh's employees speak English. "They've had fourteen years of English-speaking practice. For us, the main language is English," he says. The accent, however, is a bigger issue. Therefore,
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Daksh agents receive 80 hours of accent neutralization training to help them neutralize their accent to something that can be clearly understood globally. Another concern in deciding whether to outsource call
centers is the loss of U.S. jobs. The move to outsourcing could see as many as 3.3 million U.S. jobs and $136 billion in wages shuffled offshore in the next decade, with almost three quarters going to India, according to Forrester Research. But the lure of lower-cost workers and facilities and higher retention rates is often too great to ignore. Sprint is considering outsourcing certain technology jobs and sending them overseas, a possibility that could lead to hundreds of layoffs, according to an August report from the Associated Press. Sprint was forced to consider offshore outsourcing because of competitive pressures, says Sprint spokesperson Melinda Tiemeyer. "It's purely a business decision," she says. A 2002 Datamonitor study found that a 150-seat call center that costs $5.6 million to run for a year in the U.S. costs just $2.2 million in India. The research firm predicts that the number of people working as outsourced call center agents will double by 2007. It expects these agents to increasingly come from offshore locations. The pride in the work in India and other regions is another advantage of offshore outsourcing, says Elizabeth Herrell, an analyst at Forrester. "There is a large offshore source of multilingual personnel, higher- educated agents and you can get lower salary levels depending on where you are located,"
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Herrell says. "They are also frequently providing some form of technical expertise, and many companies already have the technology in place, especially in India." Herrell warns that in addition to cultural
misalignments, there are other risks in offshore outsourcing, for example, lack of consistency between call centers and lack of control over management. Industry experts agree that outsourcing does not absolve an organization of its responsibility to customer service. "Even when you outsource you have to be in control of the business from a planning and management sense. Think about how you will train and manage the service provider a half a world away," Barry says. If you're skittish
about bringing your customer service solution overseas, Herrell says there is another option. "Outsourcing is growing because of the high cost of setting up call centers. But I wonder why more companies don't look at alternative choices like voice automated systems and voice over IP to handle very basic types of transactions? The technology has made it easier." Advanced Speech Recognition, whether done in conjunction
with offshore customer service efforts or to cut costs and keep call centers in the U.S., companies are slowly warming up to advanced speech recognition (ASR) technology solutions. ASR technology enables customers to speak entries to navigate through an automated telephone system, rather than punching numbers on a telephone keypad. Basic ASR systems recognize single-word entries like yes-or-no responses and
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spoken numerals, making it easier for people to navigate through automated telephone menus. Sophisticated ASR systems enable users to enter queries or responses, such as a request for driving directions or the telephone number of a hotel or retail store in a particular town. This shortens the menu navigation process by reducing the number of decision points. ASR marks a categorical improvement over manual keypad entry technology that requires people to punch in telephone keys, because it helps to eliminate errors caused by pressing the wrong key, contributing to customer frustration. When this happens customers either press zero for a live customer service rep or abandon the call altogether. By minimizing the amount of what is commonly referred to as a zero-out command, organizations can reduce the amount of customer service reps needed to field basic calls. The remaining call center reps can then be trained for more rewarding jobs, which include sales, complaint resolution, or customer retention. Customer care outsourcer Sykes Enterprises, for example, formed a partnership in April with NetByTel to incorporate its advanced speech recognition solutions into business process outsourcing services. "Advanced speech recognition
and voice-enabled applications are key," says William Sokol, senior director of strategy and marketing at Sykes. "To date the biggest obstacle preventing it has been the ridiculous amount of cost and time it takes to adopt. That's why we formed the relationship with NetByTel." Sokol says
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an ASR system can be billed on a transactional basis for 35 cents per minute, with a typical set-up fee of less than $50,000, which he says is a reduced cost-of-entry of approximately 90 percent below previous ASR system implementations. ASR applications, Sokol suggests, are most appropriate for customer support of consumer products, as well as service for financial services firms. These include calls seeking store locations, password resets, and order status updates. Proctor & Gamble receives an average of 13,000 calls per day regarding coupons offered for its Swiffer Sweeper product. To help with these call volumes, P&G signed one of Sykes's largest outsourcing contracts this past June--a five-year global customer care--services deal worth an estimated $70 million. Sykes and P&G plan on partnering--and using speech-recognition technology--to handle some of the more than 6 million customer service inquiries annually on nearly 300 P&G brands worldwide. P&G said it would use Sykes's IT infrastructure and global network of support centers to enhance its consumer relations services, as well. "Our
relationship will better enable P&G to serve consumers with excellence around the world and better utilize vital consumer data to further improve our products and services," says Charlotte Otto, global external relations officer for P&G. The global implementation will begin this month and expand to all designated locations worldwide over the next few years. Sykes expects to manage about 70 percent of P&G's global
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consumer contacts. Most of the U.S. calls will be out of Sykes's data center in Palatka, FL, near Jacksonville. Calls from Europe will mostly be fielded by a center in Edinburgh, U.K., while the Asia market will be handled by centers in Costa Rica and the Philippines. Some additional calls will go to Sykes's centers in Bangalore, India, and Sao Paulo, Brazil. Convergys also uses ASR technology to attract customers. "Our voice solutions platform is state of the art," Ross says. "It's about getting clients comfortable with automating that part of their business. There's no question that the cheapest agent is the silicon agent." To compete
for business, call center outsourcing companies will clearly be among the first to use the most advanced call center technologies. Whether considering an offshore or a U.S.--based outsourcer, the financial and operational advantages of partnering with an outsourcer are compelling. "It comes down to economics," Barry & Company's Barry says. "In this environment some companies just do not want to spend the money on systems, facilities, and people." Philippine Studies Call center agents earn more than most of their peers in other industries, but some may pay for it with abnormal sleeping habits, habitual drinking, illegal drug use and risky sexual activities, a recent study said.
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The study, by the University of the Philippines Population Institute (UPPI), reported that some call center agents in Metro Cebu and Metro Manila do earn more and get better benefits than non-call center workers. However, some of them face higher health risks. The study, conducted by an eight-member group led by Dr. Maria Midea Kabamalan, was presented yesterday in Cebu City. The Population Commission (Popcom) funded the study, The Lifestyle and Reproductive Health Issues of Young Professionals in Cebu and Metro Manila. It sought to examine the profile of workers in call centers and other establishments, and compare their lifestyles, health and reproductive health status. At least 929 respondents participated. They belong to the 18-34 age group and had at least two years of college education. An equal number of male and female respondents participated. The study revealed that call center workers are more sexually active than other workers, but only minority have been tested for the human immunodeficiency virus (HIV), which causes Aids. Twenty percent of the male respondents and eight percent of the females told researchers they have been tested for HIV. But 50 percent of the male agents and 36 percent of the females said they are willing to undergo HIV tests. The survey results were reported on the heels of a
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Department of Health report about an alarming increase in HIV cases in the country, with 709 new cases reported from January to October 2009. In April 2008, Sun. Star Cebu published a special report by some University of the Philippines students, who interviewed some call center workers about lifestyle changes like illegal drug use, casual sex and pregnancies out of wedlock. The new study revealed that Cebus call center workers earn less than Manila-based counterparts, but more than those who dont work in call centers. They earn so much than non-call center workers that most of them support their parents and siblings, but are still able to save a part of their income regularly, said Dr. Josefina Natividad of the UPPI research team. Compared to Manila-based call center workers, Cebu-based call center workers, in general, have more benefits. These include life insurance, meal allowances, rice allowance, incentives, dental and medical insurance. Cebu-based call center agents also reported receiving extra benefits like free travel (31 percent), hazard pay (56 percent) and commissions (81 percent). Natividad said the government should examine the high prevalence of premarital sex and risky sexual activities among call center agents.
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But she added that other young professionals who dont work in call centers need to be studied as well. The research team reported that regardless of gender, 65 percent of the call center agents surveyed have sex, compared to 53 percent among non-call center agents. At least 3 out of 10 (34 percent) of the male call center agents reported having unprotected sex, compared to 19 percent of the females. Four out of 10 male respondents, whether working in call centers or not, reported having sex with multiple partners. Eighteen percent of the male call center agents told researchers they have regular sex with a partner they have no romantic feelings for their buddies. Eleven percent of the females reported the same practice. The researchers reported that on average, call center workers get 6.2 hours of sleep per day, compared to non-call center workers who averaged 6.5 hours of sleep. They added that 45 percent of call center workers (regardless of sex) reported having problems falling asleep. The researchers noted that two-thirds of these young workers drink coffee daily, with call center workers drinking more coffee (2.3 cups) than non-call center workers (1.7 cups). Half of the respondents drink soda daily, with an average of 1.5 bottles per day, while 15 percent reported they drink energy drinks daily. Less than half (47 percent) of call center workers regularly eat
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three meals a day. More female call center workers skip meals, with 40 percent skipping breakfast, 20 percent skipping lunch, and 16 percent skipping dinner. In general, there is a high level consumption of chips, burgers, fries and fried chicken among call center and non-call center workers. But in Cebu, the survey showed, call center agents reported lower consumption of these food items compared to Manila-based agents. The study also reported that 43 percent of call center workers in Cebu and the National Capital Region smoke, a larger part of the population than the smokers among those who work elsewhere. Cebu-based call center workers consume one cigarette during office breaks, compared with Manila-based call center workers who average 1.2 sticks. At least 85 percent of call center workers confirmed they regularly consume alcohol, compared to 87 percent of non-call center workers. The survey also noted that 11 percent of call center workers used drugs in the past six months, with marijuana as the most common substance, followed by shabu. Sixty-one percent of the Cebu respondents confirmed they tried using shabu, compared to 29 percent of Manila-based call center workers. Popcom 7 Director Leo Rama said the study should open the eyes of local officials, amid efforts to promote Cebu as a business process
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outsourcing (BPO) hub in the country. This is just the first study, but more studies will be conducted that may assist the BPO industry, which is growing, said Rama It's rare when it happens, but when miscalculations enter a call center the results can be catastrophic. Curt Barry, president of F. Curtis Barry & Company, a Richmond, VA, operations and fulfillment consultant, recalls one unfortunate catalog company that had a holiday gift business with a severe peak period. It contracted with an offshore call center that miscalculated the peak transactions volumes and had no way to recover. The result was a phone system with limited routing
capabilities and an insufficient number of agents fielding calls. The catalog had a high call abandonment rate, because callers were placed on hold for too long or in some cases could not get through at all. When the holiday season was over, the company's outsourced call center had experienced a 24 percent abandonment rate, effectively destroying the catalog's seasonal business. "While call center problems can happen anywhere, it's a situation that is exacerbated by having your call staff in another part of the world," Barry says. Shift work has been reported
to affect the workers health and well-being. However, the many interacting factors involved in shift work make it difficult to understand the mechanism underlying its effects. The currently rising demand for shift workers in the Philippine business process outsourcing (BPO)
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industry, particularly in the contact center sector, has spurred increased interest in research on the effects of shift work Filipino workers. The fact that shift work affects employees health and well-being, and in turn affects economic productivity, gives enough reason for doing shift work studies. In this paper, we review research publications, project reports and theses (graduate and undergraduate) to determine the current state of knowledge on shift work in the Philippines and to define future research directions. Results of this review indicate that many aspects of shift work have been explored in studies in the Philippines, but there is still a big gap in knowledge that needs to be addressed. While there are studies that investigated health effects, job satisfaction, job performance, lifestyle, risk behaviors and other topics, the number of studies done in the country is still quite limited and the variables investigated do not allow comparison with situations in other countries. There is still a need for more detailed studies to be able to provide empirical evidence on shift works effects on Filipino workers and to be able to make relevant interventions to improve the workers health and well-being. In terms of research questions, there are no local studies that looked into chronic diseases such as cardiovascular diseases and cancer. There are also no published studies yet that investigated the Filipino chronotype in relation to shift work. The chronotype characterizes how an individuals internal biological clock synchronizes to the external clock. The importance of
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chronotype in shift work research has been shown in studies in other countries. However, the chronotype variation among Filipinos is not yet known. Other untapped topics on shift work research in the Philippines include light and shift work, speech ability and shift work, actual physical work load and time pressure, exposure to heat, dust or other hazards during shift work, dermatological problems related to shift work, genes and shift work, social and psychological aspects of shift work and long term effects of shift work. We also included here a framework of research approaches on how to thoroughly investigate the effects of shift work on the workers health and well-being. The framework was adopted from the European project consortium called Clock WORK which aimed to optimize the individuals structure of work, free time and sleep. An offshoot of the Clock WORK project is the PhilSHIFT initiative. PhilSHIFT is an interdisciplinary group of researchers from the University of the Philippines and the Ludwig-Maximilians University at Mnchen studying chrono-type variation among Filipinos and shift work in the Philippines. The effects of shift work on a persons health and wellbeing have been shown in several studies. Acute health effects (e.g., sleep and digestive disturbances), chronic effects (e.g., metabolic and cardiovascular
pathologies and increased cancer risk) and social effects have been reported in different shift work studies (Kantermann et al. 2010). Recently, public awareness on shift work in the Philippines has
32
increased with the quick rise in the past ten years of the business process outsourcing (BPO) industry in the country. The BPO industry provides services which include medical transcription, computer
animation, software development, engineering and architectural design, back office operation, human resource management services, and other professional services, with the contact center or call center sector as the biggest component (Sibal 2011). Professional organizations in the Philippine BPO industry include the Animation Council of the Philippines Incorporated, Business Processing Association of the Philippines,
Contact Center Association of the Philippines, Gaming Development Association of the Philippines, Health Information Management
Outsourcing Association of the Philippines and the Philippine Software Industry Association. The booming industry which employs mostly shift workers has 18 expanded at a fast rate in the last decade contributing revenues of 350 million U.S. dollars (USD) in 2001 to 7.2 billion USD in 2009 (UPDPI/ILO 2010). The BPO industry in the Philippines currently employs around 400,000 employees (Bajaj 2011). Most of these employees are shift workers. Non-shift workers in the industry are usually those with administrative positions. The Philippines surpassed India as the leading BPO provider in 2010 in the pure voice-based revenue (Lal 2010). Continued growth of the industry is predicted with a yearly increase of 25 to 30 percent in financial benefits (Bajaj 2011). The
33
currently rising demand for shift workers in the Philippines especially in the BPO industry indicates positive economic effects. However, it also poses several issues and concerns about its shift workers. The fact that shift work affects employees health and well-being and in turn affects economic productivity spurred interest among several investigators to study it in detail in different settings. This paper aims to determine the current state of knowledge on shift work and its effects on the Filipino workers and to define future research directions in studying shift work in the local setting. We do not intend to do a meta-analysis of previous studies in this paper. And although the aim is to learn what is known in Philippine literature about shift work effects, we only present here a general description of the studies and an overview of results. Some of the reviewed studies have more information to offer while others have less. In other cases, we are also limited by the availability of the complete research report. We hope that the general information presented in this paper would help generate ideas for researchers who want to pursue the topic. The readers who are interested in details not mentioned in this paper (e.g., procedures used in the data collection of each study, sociodemographic details, statistical methods employed, technical
definition of variables and other terms) may want to look into the cited original publications or research reports. This paper is divided into five major parts: (1) definition and evolution of shift work in the Philippines,
34
(2) description of local shift work studies, (3) findings of local shift work studies, (4) gaps in knowledge, future directions and issues in shift work research, and (5) recommended approaches in shift work research. In a rough and general sense, shift work is an employment practice that involves different work schedules or shifts aside from the usual standard day shift (e.g., 8 a.m. 5 p.m.). It is a mode of scheduling hours of work to ensure continuity in the service or production process. Others loosely define it as an arrangement that involves irregular hours or rotating hours. Kantermann (2008) presented different aspects of shift work, which make it difficult to have a simple universal definition. Shift work schedules can be described in more detail other than categorizing it as morning, midday or night shift. A shift work schedule can also be characterized by the direction of schedule rotation. For example, a worker can have a clockwise or counterclockwise rotating schedule or just a permanent morning or night shift work. The frequency of shift rotation and the length of shift work in hours are also important aspects to consider in defining shift work schedules. Unfortunately, many shift work studies fail to characterize the different aspects of the shift work schedule. Kantermann (2008) also advised researchers to carefully interpret results of studies which only measured the total years of shift work that an individual experienced. Shift work schedules may vary
greatly between industries within a country and also between countries.
35
In the Philippines the shift work system commonly implemented in the manufacturing and service industries from the early period of its industrial undertakings is categorized as continuous, semi-continuous or discontinuous. A continuous shift system operates around the clock without a daily or weekly break and without public holidays. A semicontinuous shift work also operates around the clock without a daily break and may also operate on public holidays but has breaks on certain days such as weekends. On the other hand, a discontinuous shift work operates less than 24 hours a day and therefore includes a daily break and usually a weekend break as well (Manigque et al. 1985). Shift schedules are arranged to comply with the normal eight hours of work provided by law. In an industry operating on a continuous or semicontinuous shift system, three types of shift schedules are defined, i.e. first, second and third shift. Usually, the shift time schedules are defined as follows: first shift : 6 a.m. to 2 p.m. second shift :2 p.m. to 10 p.m. third shift or graveyard shift : 10 p.m. to 6 a.m. Other companies use different starting times such as 8 a.m. or 11 p.m. for the first shift. During shifts, meal and coffee breaks can be availed by employees and those who work between 10 p.m. and 6 a.m. receive an additional pay. In accordance with Article 86 of the Labor Code of the Philippines, the hourly additional pay of an employee working between 10 p.m. and 6a.m. should not be less than 10 percent of his regular wage per hour
36
(Presidential Decree No. 442 1974 (art) 86). Shift work schedules may be affected by the demand for the services or products, number of available workers, availability of raw materials and other factors. When there is a high demand for products or there is a depleted number of workers, shift schedules may be made to overlap and workers can also render overtime services. A 12-12 hour scheme is sometimes practiced in some companies, allowing workers to work four extra hours beyond their usual number of working hours (Manigque et al. 1985). Aside from the
BPO industry, establishments such as hotels, restaurants, shopping malls, entertainment businesses, security agencies, transport
establishments and health care industries also employ a lot of shift workers. The shift work schedule in these establishments also varies. Some have longer and irregular shift work schedules. Nurses, for example, routinely work long shifts and sometimes need to do mandatory or unplanned overtime. They work irregular day and night shifts with most of them working more than 40 hours a week (De Castro 2010). Before the entry of the BPO industry in the Philippines, nurses were the typical subjects in studies concerning shift work, occupational health, job satisfaction and performance evaluation. With the surge of the BPO industry at the start of the century, shift work in the Philippines became more associated with contact center or call center employees than with factory or hospital workers. A new group of shift workers evolved from
37
the increased demand for employees in the contact center sector of the BPO industry. Compared to manufacturing industry and health sector workers whose shift schedules are primarily designed based on product demand and availability of employees, the BPO industry shift schedules are primarily adapted to the time zones and geographical location of clients. For example, a work shift from 6p.m. to 3a.m. (Manila time) is oriented towards servicing US East Coast clients while the shift from 3p.m. to 12 noon is for servicing clients in the US West Coast. The scheduling is also affected by the nature of the line of business, business seasonality, employees technical expertise and language skills.
According to the Business Processing Association of the Philippines (BPAP), shift work schedule in the Philippine BPO industry can be generally categorized as follows: Morning shift : typically starts before 12 p.m. - for regular office functions of the company (e.g., human resources); also for Australia / New Zealand client support; Mid shift : typically starts between 12 p.m. to 3 p.m. for UK client support; Night shift : starts after 3 p.m. for US client support. Shift workers may
be assigned on permanent shift or may assume rotating shifts. Permanent shift workers work only on one shift schedule (e.g., closing shift) while rotating shift workers change their shift schedule after a certain period. Many BPO industries adapt a permanent shifting schedule for their employees but allow change of shift schedule on a case
38
to case basis. Increased attention in local shift work research has been focused lately on shift workers in contact centers because of their continuously rising proportion in the Philippine workforce. Concerns about their health and welfare became interesting themes in shift work research Description of Shift Work Studies in the Philippines . The
earliest documented study of shift work in the Philippines dates back to the early 1980s in an exploratory study conducted by the Institute of Labor and Manpower Studies (ILMS) of the Ministry of Labor and Employment (or MOLE, now the Department of Labor and Employment). The study was supported by the International Labor Organization (ILO) and conducted on manufacturing and mining industries which first adopted the shift work system. The reported number of shift workers in December 1980, based on the Integrated Quarterly Survey of
Establishments done by MOLE, was 794,000. This was roughly 5% of the total 17 million employed in 1980 (Manigque et al. 1985). Nine firms were randomly selected from the top 100 corporations in the Philippines to participate in the ILMS study. The study provided baseline information about the working conditions of shift workers at that time. It investigated shift work schedules, length of shift work per day, remuneration for doing shift work, social services for shift workers, problems encountered in shift work and the advantages and disadvantages of doing shift work. Although informative in many aspects, the study was limited in its
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statistical analysis. Following the ILMS study were mostly studies conducted on a smaller scale (e.g., involving only one Philippine company). In this paper we focused mainly on researches relevant to the current shift work situation in the Philippines. Thus, we searched for studies related to shift work conducted from year 2000 up to the present. This review is not a usual systematic review. Other forms of nonsystematic search such as asking experts for research papers and project reports were employed because of the very few published literature on shift work in the Philippines. Initially PubMed database was used for looking for journal articles online. The search terms used were: shift work and philippines. This gave only 6 research publications and not all of them were related to what we need. Google Scholar search engine was used instead of PubMed. It gave more results including the ones shown in PubMed. Using the terms shift and work entered simultaneously resulted to almost 4 million articles excluding patents in Google Scholar. Adding the word Philippines, narrowed down the research result to 171 thousand web pages. Further limiting the search to articles with abstract, results and conclusion gave 36 thousand web pages. Modifying the search criteria using more specific terms (i.e. "shift work" OR "shiftwork" OR "night work" OR "night job" Philippines study abstract results conclusion) resulted in 591 articles. Excluding blog pages finally resulted in 573 articles. The titles and displayed text of these articles
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were manually checked to determine the relevant ones. During the manual checking, studies that were conducted from year 2000 to present and which looked into effects of shift work or its relationship with other factors were read in detail. Online news articles or documents that only cited shift work statistics or basic information were not selected. Due to the limited number of related peer reviewed publications, efforts were also made to look for research articles, reports and theses (graduate and undergraduate) with at least an abstract. However, not all of them are accounted for in this literature review. Most research reports and theses are only available in print in local university libraries or research offices and not easily accessible to the general public. Other documents only became known to the authors through contacts with experts or word-ofmouth. In the end, only 30 studies qualified for this review. Study Design. Studies on shift work in the Philippines are in general observational field studies. Most are purely descriptive studies, while some are analytic in nature. By study design, most are classified as cross-sectional studies where all factors are measured from the study subjects at one particular point or period in time. Survey methods are usually employed in cross-sectional studies. There are also those which are classified as case studies. They describe only a specific workplace and have data from key informants or a limited number of respondents. Case studies are usually done as a preliminary step to a large survey or
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bigger research endeavor. A few studies managed to implement a cohort design and followed-up the study subjects for the measurement of an outcome. There are no published studies yet of laboratory experimental studies related to shift work in the Philippines. One undergraduate thesis (Averia et al. 2001) which reported to have implemented an experimental design in hospital shift work measured the nurses scores in mental health, fatigue, memory and response to stimuli tests to be able to recommend an optimal shift work schedule. Other studies (e.g., Keitel 2009) did not collect data from shift workers but instead reviewed records related to laws, policies and other issues related to shift work. Study Area. Earlier studies on shift work include rural areas covered by mining industries, but recent shift work studies are mostly done in urban areas because the usual target subjects are either based in hospitals or offices. Metro Manila is a commonly chosen study area primarily because most BPO offices are located in the city. Other cities in the Philippines such as Metro Cebu which have contact center offices are also included in some studies. There is no study yet that characterizes shift work conditions in the whole archipelago. Most studies only focus on selected urban areas where many shift workers can be found. Study Subjects. Recent studies on shift work include contact center employees and other BPO industry employees as participants. Health care workers such as nurses were also typical subjects in earlier
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studies. The subjects of shift work studies are usually the young, economically productive age group. In studies which investigated contact center employees, the ages of study subjects usually ranged from 20 to 35 years old. Aside from contact centers and hospitals, study subjects have also been recruited from manufacturing industries (e.g., semiconductor and yarn companies), aviation companies, wholesale and retail trade, hotels and restaurants, transport, storage and communications, real estate, renting and business sector, security agencies, educational and financial institutions. Methods of data collection. All shift work studies in the Philippines are field studies. There are no studies yet performed directly in a laboratory or under simulated situation outside the real-life work setting. Like other studies in previous developed countries, researches reported difficulty in recruiting companies and employees to participate in shift work studies in the Philippines. Study subjects are usually recruited by convenience sampling due to limitations in implementing random sampling or other special sampling strategies. Subjects participate voluntarily in researches and the most common method of data collection is via self-administered survey questionnaire. Other studies conduct focus group discussions (FGDs), key informant interviews and face-toface interviews of the study subjects. In a few studies, collection of physiological data such as heart rate and temperature was done. It is
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rare to find a study with repeated and follow-up data collection method. Follow-up of participants for repeated data measurement is not easy to do especially in contact centers because of the fast turnover of employees. This situation may alter the individual shift work exposure and possibly introduce bias to the research result. One of the cohort studies (OHSC 2001) included in this review followed up employees for only a few weeks. The other cohort study (Marquez 2000) implemented a retrospective cohort study design and reviewed past records for data collection Factors investigated. Shift work studies in the Philippines have investigated different factors in search of possible explanations of shift works effects on health and well-being. Demographic
characteristics such as age, gender, marital status and place of residence are routinely included in most investigations. Educational background, work experience and socioeconomic status are also commonly asked. As outcome variables, studies commonly investigate health factors in relation to shift work. General, mental and reproductive health, health perception and condition, health complaints (e.g., musculoskeletal complaints, fatigue, and stress), health and safety hazards at work and nutritional status are examples of health factors investigated. Other studies (e.g., Dominguez et al 2006, Palabay and Jorge II 2007) looked into the level of sleepiness and sleep quality of Filipino shift workers. One study (Manuel and Ramos 2008) describes environmental factors that
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affect the quality of sleep of contact center employees. Job satisfaction and performance, work-life balance, quality of life and physical activities in relation to shift work have also been investigated. Some studies (Adala et al. 2007, UPDPI/ILO 2010, Marcos and Mariano 2008)
comprehensively investigated workers lifestyles by collecting data on consumption, expenditure, saving, diet, smoking and drinking habits, drug or substance abuse and leisure. Marital relationship, social interaction and sexual activities have also been explored in a few studies conducted in Metro Manila and Metro Cebu. Research papers on legal aspects (e.g., labor laws and policies) of shift work are also found in the literature (UPDPI/ILO 2010, Keitel 2009). One main aspect that differs across shift working studies is the definition of shift work. Most studies loosely defined the term and categorized shift work simply as day and night shift without specifying the shift schedule. Other studies add further information about the frequency of shift work rotation -- whether it is done every 15 days, every 3 to 6 months or as required. However, there are also studies (e.g., Magpili, 2011) which only looked at one shift schedule. The big variability in defining shift work as a factor in shift working studies poses difficulties in making general recommendations from the results of all studies available. Many factors are still untapped in the field of shift work research in the Philippines. For example, circadian or biological clocks which control physiology and
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affect mental and physical performance (Kantermann et al. 2010) are not given much attention in the Philippine setting. In general, circadian research is not a well explored topic in the Philippines. There is one published study by Jurao et al. (2008) on the effect of circadian rhythm among Filipinos, but this was done in relation to nephrotoxicity of aminoglycosides among hospital patients and not in relation to work and shift workers. Cancer and other chronic diseases in relation to shift work are also unexplored topics in local studies. Findings of Shift Work Studies in the Philippines. Given that most studies on shift work in the Philippines are cross-sectional in design, one cannot simply assume causal relationships between predictor and outcome variables that show significant associations in the study analysis. The succeeding sections describe the important findings in relation to the effect of shift work on an individuals health and well-being in Philippine studies. Health. Studies that investigate the health effects of shift work have looked into different aspects. Musculoskeletal disorders involving the neck, upper back, lower back, right shoulder, upper right arm, hand and wrist have been reportedamong Filipino shift workers in several researches (OSHC 2003, Jayme and Capio 2004, Asis et al. 2006). Semi-conductor workers with shorter shift (8 hour) rotation have been found to have a higher proportion of occupational diseases compared to workers with longer shift (12 hour) rotation (Gutierrez 2003). In a study among nurses, non-
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day shift work schedules and working mandatory overtime are associated with work-related injury and work-related illness (De Castro 2010). The study reported that 65% of nurses study participants worked more than 40 hours per week, and 23% had shifts lasting beyond 8 hours a day. More than a third of the nurses reported working a shift other than a regular day shift and 83% worked mandatory or unplanned overtime at least once per month. In terms of length of overtime work, 42% of the nurses in De Castros study worked 116 hours of overtime per month. In contact centers, health complaints concerning the eyes, cough, voice disorders and insomnia are common (OSHC 2003, Asis et al. 2006, Ho et al. 2008). The study of Dela Cuesta (2004) has shown that the work-rest ratio among outbound contact center employees is a significant predictor of the probability of workers health complaints. An increase in shift length and more work days (i.e., 6:1 work:rest ratio) both increased the probability of workers health complaints. Not only the health of the workers but also their productivity is affected. Contact center employees have lower success rate of calls when assigned to the afternoon or evening shift. In Dela Cuestas study, the success rate of call is defined by the probability of having an 80 percent or higher productive calls to total calls ratio. Shift workers in contact centers have also shown job related psychosocial stress which might be attributed to the high workload, excessive supervision and monitoring, job insecurity and
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unpredictable work schedules (OSHC 2007). Manuel and Ramos (2008) also affirm the difficulty of maintaining work-life balance among BPO employees, most of whom work in contact centers. In addition, night shift contact center employees have been reported to have lower general wellbeing compared to day shift employees (Geronimo et al. 2009). Nutritional status is another health aspect investigated among contact center employees. The study of Adala et al. (2007) in a selected contact center found that 75% of its employees have normal body mass index (BMI) while the rest are either overweight, obese or underweight based on the BMI classification for adults. Meal patterns and dietary intake were also determined in the study using the Food Frequency Questionnaire and the 24-hour Food Recall method, respectively. The results for vitamin A, vitamin C, Thiamin, Niacin, and Riboflavin were adequate based on the recommended dietary allowance. This is probably due to the employees intake of vitamins and dietary supplements. However, Calcium levels were found to be inadequate. In another study by Marcos and Mariano (2008) on eating habits and health of call center employees assigned on graveyard shift, no serious health risks have been found to be related to the employees eating habits. Most of the complaints were common colds, cough, migraine and back pain which the researchers said can be attributed more to the physical environment, stress and nature of the job than to shift work per se. However, it should
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be noted that the study might not have enough power to analyze thoroughly the relationship of eating habits and health because of the limited number of study subjects (n=30). Physiological aspects have
also been studied among shift workers in the Philippines. In a study which investigated female shift workers in a yarn manufacturing company, only marginal changes have been noted in the heart rate and body temperature, which were monitored for three days on both day and night shifts, suggesting that the shift workers are already adapted to the shift work (OSHC 2001). The study, however, had very limited sample size (n=15) and had recommended measurement of long-term changes in the physiological parameters. Sleep Quantity and Quality. Sleep
duration, sleep quality and daytime sleepiness have also been described in some shift work studies. One of the studies of the Occupational Safety and Health Center (OSHC 2001) observed the duration of sleep in a group of shift workers exposed to a 3-shift system (i.e., 6 a.m. to 2 p.m. or day shift, 2 p.m. to 10 p.m., 10 p.m. 6 a.m. or night shift) that rotates every 15 days. The observed duration of sleep did not significantly change between days within a particular shift schedule. But comparing the duration of sleep between the day shift and the night shift, they noted longer sleep hours during the first two days of night shift compared to the first two days of day shift. Perceived soundness of sleep of the workers in the same study did not differ within a shift and
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also between day and night shift. In another study conducted by Dominguez et al. (2006) on sleepiness and sleeping patterns among air traffic controllers and communicators, the prevalence of excessive daytime sleepiness (EDS) measured by the Epworth Sleepiness Score (ESS > 10) was 63%. EDS was found to be more common among shift workers than among those who worked fixed hours. In a similar study on contact center workers and regular office workers, Palabay and Jorge II (2007) reported 55% prevalence of abnormal daytime sleepiness (ESS > 10) among the contact center shift workers and 10% prevalence among regular office workers. No correlation was noted by the study group between ESS and hours of shift, order of shift rotation, duration of rotation of shift schedule and number of days off. Prevalence of insomnia (36%), restless leg syndrome (4%) and Obstructive Sleep Apnea (7.4%) among call center workers were also observed in the study. The prevalence of insomnia among call center workers (36%) was significantly higher compared to the prevalence among regular office workers (10%). In addition to loss of sleep, a high level of anxiety is another direct effect of night shift work. This was observed among security guards by Bayot (2004). Security guards either smoke or drink coffee or other energy drinks to be able to avoid sleepiness during night shift work. Poor quality of sleep and lack of sleep cause dissatisfaction among night shift workers. In a recent descriptive study of Magpili (2011) on sleep and
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environmental factors, 64% of the night shift contact center workers who were interviewed said that the environmental factors affect their sleep the most. Topping the list of factors is noise. Other factors mentioned by the respondents that affect their sleep were bright lighting, warm
temperature, not being used to daytime sleep and uncomfortable sleeping areas. Job Satisfaction/ Performance. Some studies looked into job satisfaction and performance at work of shift workers. Job satisfaction is also usually reflected in employees complaints.
Dissatisfied employees experience more psychological distress and physical health problems (De Castro 2008). Work stress is also correlated with sleep problems (Ho et al. 2008). In contact centers, employees complain of high stress level which is one major reason for the high turnover rate of employees in the industry. Despite the good
compensation and benefits in contact centers, the industry experiences high attrition rates (Abadilla 2010). Limited opportunities for promotion, night shift schedule, type of task and recognition at work are among the top reasons for high attrition cited by Sibal (2011). In one study, gender has been noted to be a significant predictor of job retention of contact center employees. Male employees were observed to less likely leave the job compared to female employees (Jamandre 2008). However, this cannot be generalized to the whole contact center sector as the study only looked into one contact center company. With respect to job
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performance, Alfaro et al. (2005) reported in their thesis that among phone bankers in a banking call center, job performance ratings significantly vary between shifts. The study noted that majority of phone bankers did not comply with call handling criteria and significant factors related to work performance include civil status, previous work experience in a similar field, average duration of sleep, feelings of fatigue associated with both work duration and rest period, work environment and motivation. In another thesis by Averia et al. (2001), this time involving rotating nurses, job performance was evaluated using memory error rate. The authors reported that nurses assigned in the night shift experience a significantly higher memory error rate, poor mental health, more subjective feelings of fatigue, and longer stimuli reaction time as compared to when they were assigned in the morning shift and to those with permanent shift schedule. In a similar thesis study on nurses done by Marquez (2000), it was found that there is a difference between the 8hour and 12-hour shift in terms of the quality of work of nurses. The completion of the Intake and Output (I&O) sheets is better in the 8-hour shift while the completion of the IV fluid sheet is better in the 12-hour shift. However, it was also noted that the length of shifts of nurses does not affect the completion of the medication and doctor's orders sheet. Lifestyle and Risk Behaviors. The University of the Philippines Population Institute recently finished a study on the lifestyle of workers in Metro
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Manila and Metro Cebu (UPDPI/ILO 2010). The study subjects were workers in contact centers and other non-contact center industries (e.g., education, hotels and restaurants, manufacturing, wholesale-retail trade, renting and business activities, financial inter mediation and real estate). The study has a relatively large number of subjects and participating industries. It included 16 contact centers contributing 675 respondents and 17 non-contact center industries contributing 254 respondents. Lifestyle factors such as consumption and expenditure, diet, smoking and drinking habits, drug/substance use, leisure activities, relationships and sexual activities were investigated. The study also looked into the level of knowledge of workers regarding reproductive health, sexually transmitted infections (STIs) and Human Immunodeficiency Virus (HIV) prevention. It has a detailed report on all the factors mentioned. Just to highlight some specific results, it was noted that workers in contact centers and non-contact centers do not significantly differ in ownership of consumer goods. However, there is a higher proportion of contact center employees in Metro Manila with cars and latest electronic gadgets such as iPod. Obviously, this is due to higher compensation enjoyed in the contact center sector. The UPDPI/ILO study (2010) also reported that contact center employees usually have irregular meals due to their irregular work schedule and majority are daily coffee drinkers and have a sedentary lifestyle. In relation to lifestyle, another study by Abesamis
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(2008)
showed
that
work
schedule
affects
the
physical
activity
involvement of call center employees. Day shift employees were found to be more involved in physical activities such as doing exercises than employees in the graveyard shift. With regard to relationships and
sexual activities, the study of UPDPI/ILO (2010) reported that workers in the contact center industry have more active and liberal sexual behavior compared to workers in non-contact center industries. The level of knowledge in reproductive health, STIs and HIV/AIDS was higher among contact center employees than among those in the non-contact center industries. However, higher level of knowledge does not always mean lower health risks. In recent studies by Melgar et al. (2009, 2010) on risk behaviors for sexually transmitted infections among contact center employees in the Philippines, high risk behaviors (e.g., unprotected sex with multiple partners, use of alcohol during sex) were noted to exist in high frequency among the respondents. Legal Aspects and Other Issues and Concerns. Labor laws and policies concerning shift work in the Philippines also received attention from shift work researchers. Keitel (2009) presented a review of provisions and amendments in existing Philippine labor laws concerning protecting women working at night. Sibal (2011) also elaborated on legal aspects and other issues and concerns in relation to shift work and the BPO industry. One important law that affects the BPO industry is the Philippine Labor Code (art) 130
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which imposes night work prohibition for women. The government enacted this law in 1974 in accordance with the International Labor Organizations (ILO) recommendation to give more protection to female workers. Recently, President Benigno Aquino Jr. signed into law the Act Rationalizing Night Work Prohibition on Women Workers. The law amended Articles 130 and 131 of the Labor Code of the Philippines, finally removing the restrictive and discriminatory provisions against women night workers. There are studies that looked into motivations, issues, challenges and coping strategies in shift work. Using a survey questionnaire, Lorenzana and Molino (2010) asked students working as call center employees regarding work motivation, challenges and coping strategies. The work motivation was noted to be high due to the financial benefit of the job. However, problems such as excessive tardiness and absences from school, difficulties meeting school requirements and passive class participation have been observed among the working students. Some managed to develop coping strategies like studying during days off and decreasing leisure time. Others resorted to engaging in smoking or drinking habits to cope with the stress. In another study that looked into issues and challenges in shift work, also among contact center employees, respondents reported poor quality of life in the physical, mental, social and emotional aspects of living (Medina 2008). The respondents also reported difficulty in handling problems and
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dissatisfaction in several areas of their life including their job. Issues and challenges in family life have also been studied in the Philippine setting. Tolentino (2008) conducted a survey among married women working in contact centers to characterize the problems and challenges encountered in the area of marital relationships. In the different aspects of marital happiness investigated, wives who work in a non-standard (e.g., graveyard shift) schedule experienced marital happiness only in the aspect of household chores. Disagreements about financial matters, problems in communication, jealousy, personal differences and
insecurities were commonly cited as problems. The study was conducted only among wives working as call center employees. Whether the observed issues and challenges are more frequent in the said group than in working wives in other industries is beyond the scope of the study. We have attempted to describe the major results of known existing researches in the Philippines related to shift work effects since 2000. There are however limitations to the coverage of this review. Other occupational studies on individual subjects that are not formally categorized as shift workers, for example workers in the entertainment business and commercial sex workers, are not included here. Although equally interesting and important, studies conducted on these groups of workers usually focus on other factors affecting health risk and not on the work or shift schedule per se. Currently, most of the recent
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researches available on shift workers in the Philippines involve the contact center industry which is one of the big revenue contributors to the country. Gaps in Knowledge, Future Directions and Issues in
Shift Work Research in the Philippines Many aspects of shift work have been explored in studies in the Philippines but there is still a big gap in knowledge that needs to be addressed in this field. While there are studies that investigated health effects of shift work, the number of studies is still quite limited considering that there are no local studies yet that looked into chronic diseases such as cardiovascular diseases and cancer. Further, no studies have been done yet in the Philippines on pharmacological interventions investigating the effects of specific drugs on improving sleep and on counteracting the effect of night work on local workers. Studies that investigated physiologic functions and other health effects are also limited in number and scope to be able to provide empirical evidence on the effects of shift work and be used as bases to make relevant interventions. There is also a need for research with stronger designs to be able to answer questions on causal relationships. As regards the role of the circadian (biological) clock which controls our physiology, behavior, mental and physical performance (Kantermann et al. 2010), there is no published study yet conducted among Filipinos in relation to shift work. Our internal biological clock which produces its own internal day synchronizes to the external 24-hour day primarily by
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the light-dark cycle and also by many other possible time-giving cues or zeitgebers. Social jetlag, with symptoms similar to the usual jetlag due to travelling to different time zones, can be experienced by individuals when there are discrepancies between the internal biological time and external social time (Wittmann et al. 2006, Mendoza and Aguila 2010). Social jetlag is a consequence of circadian system desynchronization with the external time. The relationship between the internal time and external time is called phase of entrainment. Different individuals may differ in their phase of entrainment and therefore have different chronotypes (Roenneberg et al. 2007). Chronotype may be quantified through the Munich Chronotype Questionnaire (MCTQ; see Roenneberg et al. 2003 for details). Some individuals may be an early-chronotype (lark or early bird) while others may be a late-chronotype person (owl). The chronotype plays a key role in an individuals ability to adjust to shift work (Kantermann et al. 2010). It can be used to predict the degree of sleep disturbance and the degree of distress the shift workers will experience (Juda 2010). It can also be used in choosing work schedules or in choosing the proper timing to administer drugs or perform medical tests (Lee Phillips 2009). While chronotype variation has been described for other populations, no such data yet exist for Filipinos (Manalang Jr 2011). Besides assessing an individuals chronotype, Kantermann
and colleagues also recommended assessing an individuals internal time
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or circadian phase during different shifts to be able to quantify the effect of alternating work times on an individuals biological clock and how it contributes to stress and the development of diseases. The internal time can be estimated by measuring the body temperature or the melatonin level. The melatonin level is a better marker than body temperature but it can be affected by light, medication, diet or other stimulants. In addition, measuring the melatonin level is expensive and time consuming (Kantermann et al. 2010). Currently, the technology to be able to measure internal time effectively is still being developed. Summary of Related Literature
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Chapter III Methods and Procedures Research Design This chapter describes the research method used by the
researchers, locale of the study, the respondents, sampling procedure, research instruments, data gathering procedure that were used in analysis data. Research Design The study utilized qualitative design specifically the
phenomenological approach for description, explanation and exploration. Denzin and Lincoln (2002) claimed that qualitative research involves an interpretive and naturalistic approach. This means that qualitative researchers study things in their natural settings, attempting to make sense of, or to interpret, phenomena in terms of the meanings people bring to them. Qualitative research is a method of inquiry employed in many different academic disciplines, traditionally in the social sciences, but also in market research and further contexts. Qualitative researchers aim to gather an in-depth understanding of human behavior and the reasons that govern such behavior. The qualitative method investigates the why and how of decision making, not just what, where, when. Hence, smaller, but focused samples are more often needed than large samples
60
(Creswell). The word phenomenology means the study of phenomena, and has come to mean the system described by Husserl and his followers that stresses the careful description of phenomena in all areas of experience. It is also the study of essence-what makes something what it is (Ray, 2000). An expanded definition is provided by Van Manen (2000). He states, phenomenology is the study of lived experiences, the explication of phenomena as they present themselves to consciousness; the study of essence; the description of the experiential meanings as we live it; the human scientific study of phenomena; the attentive practice of thoughtfulness; and a search for what it means to be human. The aim of phenomenology is to disclosed lived experience, but it is recognized that the closest one can come is disclosed perception (Oiler, 2006). Finally, the purpose of phenomenology is to seek the fuller understanding through description, reflection and direct awareness of phenomena to reveal the multiplicity of coherent and integral meanings of the phenomenon. Phenomenology is a well-respected and often used as method of inquiry in many disciplines including philosophy, sociology and
psychology. Recently it has gained recognition as an appropriate approach to study phenomenon of interest to nursing. Professional nursing practice is enmeshed in the life experience of people, thus phenomenology as human science research method is well suited to this
61
inquiries (Streubert & Carpenter, 2005). This study use the phenomenological approach because this method was fit to accomplish the goal of this study which was to examine the lived experiences of Call Center Agents and the meanings of those experiences from the nurses' points of view.
Locale of the Study This study was conducted in City of Cabanatuan. The City of Cabanatuan is a first class, urbanized city in the province of Nueva Ecija, Philippines. The participants are residing here presently but working as Call Center agents outside the City of Cabanatuan. The respondents chose their respective place where the researchers are very convenient to conduct the research study. The places are safe and calm and very conducive in conducting the interview.
Participants or Co-researchers This study consists of five (5) Call Center Agents who were graduate nurses. Researchers used a small number of participants gathered through purposive techniques so that a selected group of individuals with specific characteristics can be simplified properly (Smith and Osbourne, 2008). Furthermore phenomenological researches placed a higher value
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on developing a deep understanding about a participants complex experiences and motivations in life. Participant 1 is a female, unmarried, Catholic from Cabanatuan City, 24 years old and works in call center for 2 years and 3 months. Participant 2 is a female, unmarried, Catholic from Cabanatuan City, 28 years old and works in call center for 3 years and 2 months. Participant 3 is a male, unmarried, Catholic from Cabanatuan City, 22 years old and works in call center for 3 months. Participant 4 is a male, married with 2 children, Catholic from Cabanatuan City, 29 years old and works in call center for 2 years and 1 month. Participant 5 is a female, married with 1 child, Jesus is Lord Church worshipper from Cabanatuan City, 27 years old and works in call center for 1 year and 5 months.
Data Gathering Tool The researchers employed interviews mainly using open-ended questions to gather more in depth knowledge from the respondents. This method is flexible as it has the ability to get lot of useful information based from a single question. The researchers will also be using direct observation. In the direct observation method, the researcher observes
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peoples normal behavior without disturbing the situation. The term non-intrusive is also often used to describe this method to remind that the researcher should not intervene with the research settings
(Randolph, 2007). According to Taylor-Power and Steele (1996) suggest that seeing and listening are the key aspects of direct observation. The method provides the opportunity to collect such data that, for instance, might be difficult to retrieve via questionnaires or interviews. In some case, behavior of the people can also be recorded with a video camera if the respondent does permit to do so. The researchers also utilized a data collection method of content analysis to study the content and meaning of texts and information resources, such as books, essays, interviews, discussions, historical documents, speeches, conversations, websiteand images (Randolph, 2007) indicated our related literature. The researchers resort to give appropriate meanings and proper behavioral interpretation of the respondents.
Data Gathering Procedure The researchers utilized the snowball sampling or chain sampling, chain-referral sampling. It is a non-probability sampling technique where existing study subjects recruited future subjects from among their acquaintances. Thus the sample group appears to grow like a rolling
64
snowball (similarly to breadth-first search (BFS) in computer science). As the sample builds up, enough data is gathered to be useful for research. This sampling technique is often used in hidden populations which are difficult for researchers to access; example populations would be drug users or sex workers. As sample members are not selected from a sampling frame, snowball samples, analogously to BFS samples, are subject to numerous biases. For example, people who have many friends are more likely to be recruited into the sample.
Data management and Analysis Data collection was done over a certain period of time through extensive interviews. Following each interview, the researchers reviewed the tapes and made notations. The tapes were transcribed verbatimly. Data were analyzed using interview procedures adapted from Colaizzi (1978). This procedures have been used in another studies, Colaizzi's analysis has has it's aim understanding phenomena within the human experience. The steps of the method are flexible and by no means and definitive. It is also important to know that analysis is not a linear process nor can the activities we perform in a rigid sequence. Synthesis of the study was presented like a jigsaw puzzle, story telling, thematic analysis and mind mapping were utilized by the
65
researcher.
Ethical consideration Beneficence The researchers maintained the principles of beneficence,
overseeing the potential consequences of revealing participants identities. They informed the participants on how the result would be published on the other members may need to review the data also. Autonomy was diminished to protect participants from exploitation of their vulnerability. Respect For human dignity Participants have the right to withdraw to the research during the process. The researchers ensured the autonomy of research participants. The dignity of all participants was respected. Adherence to this principle ensured that participants were not used simply as a means to achieved research objectives. Justice The researchers avoided exploitation of people. Confidentiality about their experiences and the data they provided were kept private. As this study required the participation of human respondents certain ethical issues were addressed. The consideration of these ethical issues is necessary for the purpose of ensuring the privacy as well as the safety of the participants. Among the significant of the ethical issues that
66
were
considered
in
the
research
process
included
consent
and
confidentiality. In order to secure the consent of elected participants, the researchers relayed all important details of the duty including the aims and purposes. By explaining this important details the respondents were able to understand the importance of their role in the completion of the research. The respondents were also advised that they could withdraw from the study even during the process. With this, the participants were not force to participate in the research. The confidentiality of the participants was also ensured by not disclosing their names or personal information in the research. Only relevant detail that help in answering research questions were included.
Establishing Trustworthiness of Data Credibility Credibility will be attained through peer debriefing wherein in we will conduct regular brainstorming session about the data collected and made necessary revision for any incorrect approaches during the interview process. The conversation will be recorded if permitted and will recorded and permitted and will be reviewed for the evaluation. We allowed participants to verbalize their positive and negative experiences to arrive at a rich and comprehensive description. In member checking, we meet the participants and gave them the
67
opportunity to evaluate, react or add information to the data gathered. In cases that the participants will add information, all corrections and revisions will be accomplished during peer debriefing. Follow up interviews will be conducted for validation purposes. Credibility will be also be attained through setting aside a biases in order to remain focused on the participants responses. This will make possible by bracketing are own beliefs and experiences. Dependability Dependability refers to being reliable, which means data are truly trustworthy because the researchers consider ethics, morals and values in handling information. Confirmability. Confirmability is a must-which refers to capability of data to be retested or verified. Repeat interviews and observations are allowed to ensure accuracy and falsifiability. And for the completeness of trust, the researchers ensure the datas transferability. Transferability Transferability is defined as data on being legally conveyable to the ownership of another, and being Fit to the user.it is possible by the process of member checks, and enhances findings to have same meaning.

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WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

greatly between industries within a country and also between countries.

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

and colleagues also recommended assessing an individuals internal time

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING

WESLEYAN UNIVERSITY-PHILIPPINES - COLLEGE OF NURSING