During the analysis, four major themes were identified and are discussed as under:
Theme 1: Perceived knowledge, awareness, and severity of COVID-19
During the interviews, nurses were asked about their current knowledge, awareness, and severity of COVID-19. All of the respondents were well responsive to the disease dynamics and the severity level. The Ministry of Health was recognized as the main source of information [26]. Additionally, as the COVID-19 became pandemic is a limited period, nurses by them started to learn about the condition so it can be communicated among their peers and public. The nurses also reported that the information regarding COVID-19 was disseminated in a disciplined manner and hence little trouble was faced regarding evidence-based information selection when it came to COVID-19.
“The Novel Corona or the Corona disease is viral in nature. Disease origin and transmission dynamics are also frightening. This is a serious condition and needs remedial action on an urgent basis.” (N, 2)
“A deadly viral infection originating from Wuhan, China that became pandemic in no time. It is a critical situation for the world.” (N, 11)
Additionally, four of the participants also stated that in addition to the information provided by the Ministry of Health, they are in touch with online resources (WHO, CDC, UN, etc) to get a better insight into the disease and the current statistics.
“The disease is new to the world. Being a healthcare practitioner, we must get maximum information about the disease so we can manage the patients to avoid transmission and contamination. We (nurses) need to be vigilant as ignorance can cause irreparable loss to the people and society.” (N, 10)
However, two nurses claimed that the environment is overloaded with information. Therefore, at times it is hard to accept or reject the characteristics and statistics related to the disease.
“At times I am confused; there is information everywhere. Everyone (people, print, mass, and social media) is talking about Corona. There is information overload and at times it becomes a problem that what information is right and what is wrong.” (N, 4)
Theme 2: Perceived personal capability of handling and managing the COVID-19
The respondents were asked about their capabilities of handling and managing the disease. Mixed results were obtained for this assessment. A handful of the nurses were confident that they are ready to tackle the issues related to COVID-19. Furthermore, they were also positive that as the policymakers are seriously working to counter the disease, they are motivated and ready to respond to the COVID-19.
“At present, the management of COVID-19 is a procedural matter that requires both precautionary methods and treatment of symptoms. With the help of the Ministry of Health, I am well aware of the procedures and positive at the same time that we can manage the disease professionally.” (N, 1)
On the other hand, certain reservations regarding the management of COVID-19 were reported. In a general context, nurses believed that the disease is manageable under certain conditions if they are provided with the necessary equipment and facilities at their practicing site.
“We are well aware of the management protocol. The issue is about the continuous availability and accessibility of diagnostic and safety kits at the practicing site. With these materials in hand, we are ready to tackle the disease.” (N, 3)
“We (nurses) are professionals and we are always ready to face and handle a crisis. For me, it is not about a question of personal capability. You can be the best at your work, but to handle diseases like COVID-19, we need an aggressive approach with facilities and protective gear. Without these, I am sorry; the situation will deteriorate at an alarming rate.” (N, 5)
Theme 3: Perceived organizational capability of handling and managing the COVID-19
The thematic analysis reported several issues while talking about organizational capabilities of handling and managing the COVID-19. Nurses had a range of opinions and showed strong reluctance while responding to this query. Likewise, almost all respondents mentioned poor availability of protective materials (kits, masks, gloves, etc) at the practicing site thus making it very difficult for them to manage the disease.
“The hospital in normal days operates in order. However, during this crisis, we are facing a shortage of masks, gloves, sanitizers, and diagnostic kits. It is impossible to continue our services as the institute itself is facing a severe shortage of materials.” (N, 7)
Lack of workforce and deprived allocation of space was also mentioned by the respondents. It was also observed that as the hospital is already overloaded, the need for specialist physicians and nurses (infectious diseases) is imminent and should be provided to the hospital on an emergency basis.
“We are a developing nation. We are faced with limited budgets and a lack of specialized healthcare. Dealing with COVID-19 needs the experience of ID physicians and nurses and these specialists should be appointed or transfer as soon as possible to our institute.” (N, 2)
“This hospital is already overloaded. We will be unable to handle an emergency if the disease spreads to the society. We need strict measures, as like China. The authorities should immediately come up with a space designated only for COVID-19 patients and suspects.” (N, 9)
The respondents also mentioned that the Ministry is trying its level best in providing facilities to the healthcare system. Maximum efforts are in progress and at this time of crisis, it is their moral obligation to work in limited supplies and resources.
“The Ministry is serious in her approach. With the limited budget, it is still striving hard to provide facilities and materials to healthcare. Let us join hands and work in a limited environment so that a mass crisis is avoided.” (N, 10)
“Yes we have issues; every country fighting with COVID-19 is facing the same. It is high time not to brag out deficiencies and work in collaboration so that we can handle this disease effectively and efficiently.” (N, 1)
Theme 4: Barriers in handling and managing the COVID-19
Several barriers in handling and managing the COVID-19 were identified. Societal myths and religious stigma were mentioned as a potential barrier to the management of COVID-19. Relating to this observation, where certain myths are circulating in the society, stigma, and taboos are shaping as a hindrance in managing the disease. This is vital to address as people are following instructions that have nothing to do with the disease and the actual precautionary practices are avoided.
“People are recommending onion as a preventive measure against COVID-19. Some are also favoring use of ginger and garlic. I have also heard people buying and using ascorbic acid (vitamin C). This may be beneficial but the actual precautionary practices (hand wash, sneezing methods, social distancing, etc) are not in general discussion.” (N, 11)
“As sufferings and death come from Almighty and it is irreversible, people are least serious in taking preventive measures. But the Almighty has also instructed to opt for preventive measures. Although religious leaders are pushing hard to convey this message, the religious stigma is still prevalent and must be addressed on a priority basis.” (N, 8)
Additionally, panic related to COVID-19 was also reported as a barrier in handling and managing the COVID-19. As the COVID-19 started to become pandemic, the panic resulted in a shortage of masks, gloves and hand sanitizers all over Pakistan including Quetta city [27]. With unavailability of the protective materials, it is getting hard to manage and handle the patients or suspects with COVID-19.
“The disease has created a panic in the society. People have blindly purchased masks, gloves, and sanitizers from pharmacies. The smuggling of masks and gloves was also in the news. Because of this, healthcare professionals are facing a shortage in the hospitals and a barrier in providing care to patients.” (N, 9)
Another major barrier reported was the movement of suspects from cross borders. The province of Baluchistan shares its open borders with Afghanistan and Iran [28]. Pilgrims visiting Iran and Iraq from all over Pakistan travel through Quetta city. The COVID-19 being endemic in Iran places Quetta city at high risk as the pilgrims are a close suspect of carrying the virus [29].
“With a huge border, it is vital to closely monitor people entering the province of Baluchistan. Unfortunately, the monitoring started very late and there are reports that many suspects entered the province without clinical assessment and diagnosis. For me, this poor monitoring and entry of suspects is the main barrier. We have to stop the influx from the border so that we can concentrate at one point.” (N, 11)