The current study explored the lived experiences of nurses and midwives providing care in COVID-19-designated healthcare facilities in the Shinyanga, Dar es Salaam, and Pwani regions of Tanzania. Participants included healthcare professionals (HCPs) from both rural and urban settings, with a majority being female. This aligns with a systematic review of 46 qualitative studies that found a female dominance among HCPs and clients during the COVID-19 pandemic [8]. This highlights both the crucial role female HCPs played during the pandemic and the predominance of women in the nursing and midwifery professions.
The study found that nurses and midwives had commendable knowledge about COVID-19, aligning with studies from Nigeria and Ethiopia that reported adequate understanding of transmission, symptoms, and prevention measures such as hand hygiene, social distancing, and PPE use [9–10]. However, some participants incorrectly believed in using immune boosters for treatment, contradicting WHO guidelines due to inadequate evidence supporting their effectiveness [11]. While this study and others from India and Ethiopia noted satisfactory knowledge among healthcare professionals [12], gaps remain in understanding appropriate disease management. These findings highlight the need for continuous updates on evidence-based COVID-19 guidelines to ensure optimal patient care.
Several studies have highlighted the diverse roles of nurses and midwives as frontline healthcare professionals (HCPs) in the healthcare system [13–18]. Our findings revealed that these roles encompass three key domains. The first domain pertains to patient isolation, aimed at minimizing cross-infection with non-COVID-19 patients. Nurses and midwives played a crucial role in facilitating patient transfers to designated COVID-19 isolation rooms or facilities. This study, along with similar research [13,14], underscores the critical role of nurses and midwives in the initial management of COVID-19 cases and the support needed to foster resilience in their practice. The second domain involves providing comprehensive support services within hospital wards. These activities include the timely administration of prescribed medications, oxygen therapy, diligent monitoring of vital signs, and assisting with daily living activities. Nurses and midwives also performed skin care measures, such as regular repositioning to prevent bed sores, and assisted with basic physical exercises for immobile patients. These findings are consistent with previous studies indicating that nurses and midwives extended their roles to support COVID-19 victims, their families, and the broader community [14,17]. This underscores the holistic nature of care provided by these professionals, which extends beyond medical interventions. The third domain centers around psychological and educational support. Our research highlighted the vital role of nurses and midwives in offering counseling, psychological support, and health education to COVID-19 patients, their families, and friends. Previous studies have identified anxiety and lack of information as significant care needs that can be addressed through reassurance, education, and counseling [14,17]. Unlike previous studies, our findings indicate that health education provided by nurses and midwives extended beyond hospital wards to waiting areas and communities, emphasizing the community outreach aspect of nursing and midwifery services during the pandemic. Overall, these findings highlight the critical and diverse roles of nurses and midwives in providing comprehensive care to COVID-19 patients. Their adaptability, expertise, and commitment showcase the holistic approach required to address the unique challenges posed by the COVID-19 pandemic in healthcare settings.
Participants indicated that the selection of nurses and midwives to provide care in COVID-19 designated centers was primarily based on Ministry of Health directives. The criteria included being healthy (free from infectious diseases such as hypertension and diabetes), having years of work experience, holding leadership positions, having disaster management experience, and working in critical care settings. Vulnerable groups, such as pregnant, breastfeeding, and older healthcare professionals (HCPs), were excluded due to their higher risk of contracting the infection. These findings align with previous studies that identified selection criteria based on professional role, work experience, leadership position, and health status [16, 19, 20,21]. Most participants expressed fear of the disease and concern about transmitting it to their families, as they had no prior preparation. This fear was consistent with other studies reporting similar concerns among HCPs and their families [14, 15, 20, 22]. Only a few participants were positive and happy about the opportunity to serve [17]. The lack of preparation and past exposure to handling pandemics among participants contradicts recommendations by Shahil Feroz [23] that proper training and preparation of HCPs are crucial for effective care provision. The selection based on Ministry directives, without giving HCPs an option, suggests that assumptions were made about their preparedness and willingness to serve. This could have negatively impacted patient care. Similar assumptions have been noted in previous studies [16, 21].
Our research highlights the diverse and complex roles of clinical nurses and midwives in COVID-19 care facilities, categorized into direct patient care and supervisory/administrative responsibilities. Key direct care roles included needs assessments, monitoring vital signs, administering medication, ensuring patient well-being, assisting with daily activities, and maintaining cleanliness. Unlike other studies [8, 18, 24, 25], our findings also revealed that they performed post-mortem care and body transfers, tasks they found uncomfortable. In supervisory and administrative roles, they coordinated patient care, compiled reports, tracked progress, documented incidents, and addressed patient deaths. They also managed medical supplies and ensured critical equipment functionality, similar to previous studies [15,18]. These findings affirm the multifaceted nature of nursing and midwifery roles during the pandemic.
Our study revealed mixed responses regarding preparedness among healthcare professionals (HCPs) for caring for COVID-19 patients. Approximately half of the participants felt unprepared, expressing sentiments of being "just selected" or "just chosen," indicating a lack of organization and readiness in COVID-19 patient care. This finding contrasts with a survey of nursing homes in the USA, where almost all nurses and midwives reported being well-prepared for COVID-19 patient care [26]. However, in China, nurses with less than five years of experience or lower educational attainment felt less prepared [21]. Some nurses and midwives in this study, particularly leaders, mentioned receiving online or distance learning training on COVID-19 patient care, though they found it insufficient. Others cited short training sessions organized by health authorities or on-the-job training from experienced doctors, yet still felt unprepared. Additionally, some HCPs sought information from informal sources like social media and intra-facility discussions. While these sources may offer some knowledge, they cannot replace structured and evidence-based training programs. The lack of preparedness may impact the quality of care provided and HCPs' safety, affecting confidence, competence, and patient outcomes [27]. These findings align with a meta-synthesis involving 46 qualitative studies on frontline HCPs' experiences during pandemics, highlighting critical issues in preparedness, support, and social challenges faced during the COVID-19 pandemic [8]. This my partly explain why Shahil Feroz [23] consider proactive measures as essential to support and protect HCPs during public health crises like COVID-19, enabling them to cope and provide quality care.
The experiences recounted by nurses and midwives caring for COVID-19 patients in our study were a mix of positive and negative, resonating with findings from previous studies. Positive moments included witnessing critically ill patients recover and being discharged home, which nurses found rewarding and motivating. Additionally, they valued the experience gained from caring for COVID-19 patients, enabling them to extend care beyond healthcare facilities to their families and communities. Similar findings have been reported in other studies [16, 17, 20, 28], indicating shared experiences across diverse settings.Consistent with findings in Clari et al. [15], this finding implies that despite the odds, fear, and uncertainties nurses and midwives are keen to see positive health outcomes for their patients. Some nurses expressed newfound confidence in managing COVID-19 and other pandemic diseases, highlighting the learning opportunities presented by the pandemic [19]. However, negative experiences also surfaced, with nurses and midwives in both rural and urban settings facing challenges such as clients being stigmatized and abandoned by their families, leading to increased burdens and emotional distress. Witnessing patients struggling with life and lacking the means to help them was particularly distressing, contributing to psychological and emotional stress among healthcare professionals. This aligns with findings from studies in low- and middle-income countries, suggesting a global impact on healthcare workers' mental well-being [8, 18, 25, 29]. In addition, midwives caring for pregnant women with COVID-19 reported feelings of fear, anxiety, and loneliness, highlighting gaps in emotional and psychosocial support for both patients and healthcare providers. Such experiences may contribute to depression among nurses and midwives, partnly explaining why findings from other studies have reported depression in nurses and midwives who were nursing patients with COVID-19 [29]. Efforts to address these challenges and provide comprehensive support for healthcare workers are crucial for maintaining their well-being and ensuring high-quality patient care during the pandemic.
The COVID-19 pandemic has underscored various challenges in global healthcare systems, emphasizing the necessity of preparedness and responsiveness to manage infectious disease outbreaks effectively. Challenges faced by HCPs during the COVID-19 pandemic include insufficient PPE supply in Indonesia [30] and oxygen shortages in Nepal [31]. Common personal challenges include long working hours, burnout, exhaustion [32, 33], fear of infection, and inadequate preparedness [34, 35, 36]. However, diverse challenges faced by HCPs are often influenced by local contexts and healthcare systems. Chen et al. [37] noted inadequate training in China, while Greenberg et al. [38] highlighted communication issues in the UK. Despite variations, challenges appears consistent and they emphasize the need for preparedness, resource allocation, and effective communication from healthcare authorities to support HCPs and enhance patient care quality [39].
Numerous studies have examined lessons learned from caring for COVID-19 patients, highlighting critical aspects such as disaster preparedness, infection prevention, and healthcare system adaptability [39–43]. Research conducted in Italy and the United States emphasized the importance of disaster preparedness in ensuring healthcare professionals' safety and effective response to outbreaks [39,41, 42,44]. Similarly, studies from China emphasized the significance of infection prevention strategies in reducing virus transmission [45,46]. Moreover, the pandemic has emphasized the need for healthcare systems to be flexible and adaptive to promptly respond to evolving circumstances and surges in patient numbers [47–49]. Lessons learned from caring for COVID-19 patients are essential for policymakers and healthcare professionals in developing effective strategies for future pandemics. Additionally, studies have highlighted gaps in global pandemic preparedness, suggesting the importance of health system strengthening, healthcare worker capacity building, community engagement, and financial incentives [20,23,27]. Strengthening health systems, enhancing healthcare worker training, fostering community resilience, and providing financial incentives are crucial components of pandemic preparedness and disaster response efforts [50,51]. For example, Joo et al. [51] cuggested providing continuous education and training to healthcare professionals on emerging infectious diseases and pandemic preparedness and Billings et al. [8] and Shahil Feroz et al. [23] emphasized the importance of providing risk allowances for HCPs to encourage them to work in high-risk environments. However, further exploration and consideration are needed before implementing such measures. Ultimately, the lessons learned from caring for COVID-19 patients offer valuable insights into effective pandemic and outbreak management, emphasizing the need for proactive measures and continuous improvement in healthcare systems worldwide.
Limitations
This study has several limitations. Firstly, the findings are presented at a time when the global and Tanzanian burden of COVID-19 has decreased, potentially affecting their immediate applicability. However, we argue that these findings still hold relevance for informing future pandemic responses, especially for frontline healthcare workers. Secondly, our focus was solely on nurses and midwives, although other healthcare professionals were involved in COVID-19 care. While this focus aligns with our institution's primary scope, the insights gained may have broader implications across the healthcare sector. Thirdly, our study specifically targeted COVID-19 designated facilities, overlooking interactions with multidisciplinary teams in various healthcare settings before patients reached these facilities. Exploring experiences among diverse healthcare providers in different clinical settings could yield additional insights. Despite these limitations, as the first study examining the lived experiences of nurses and midwives in Tanzanian COVID-19 care, we believe our findings could offer valuable insights applicable to diverse clinical contexts. Future research could broaden its scope beyond designated pandemic facilities to encompass broader healthcare settings.