Participants in the study were anonymized using identifiers to ensure privacy. A total of eleven individuals were interviewed, comprising seven females and four males. Their ages ranged from 28 to 40 years. Among the participants, four were registered nurse/midwives, six were nurse/midwife technicians, and one was a registered nurse. In terms of their work sections, five participants worked at the female surgical ward, three at the male surgical ward, and three at the male medical ward.
The Patient care delivery practices during Covid-19 pandemic.
Three themes emerged under this study, including influence on motive of care, adaptation to Covid-19, and helping patient to adapt.
Influence on motive to care:
The responses from the participants regarding their influence on their motives to care to provide care during the COVID-19 pandemic varied but shared common themes. The primary motivation identified was the passion and dedication the healthcare professionals had for their patients. Participants highlighted:
“Passion to care for the patient and the allowance given when working in the isolation
treatment center.” (A-40yrs-Female)
The patients were losing life, so I wanted to be there for them and give them comfort
(B-30yrs-Female)
It was the passion to care and save those in need as if they are my relatives and friends.
(G-34yrs-Female)
Additionally, several participants cited financial incentives, such as allowances, as influential factors behind their commitment to patient care. The responses were:
“It was allowance (package)” (H-29yrs-Male)
“Allowance and the desire to help others” (J-35yrs-Male)
“It was because of allowance and to help patients” (K-29yrs-Female)
On the other hand, the one participant who did not work in an isolation center but attended to covid-19 patients in the ward, identified the availability of personal protective equipment (PPE) as a motivational factor. The response was:
“It was because of availability of Personal protective equipment’s” (I-28yrs-Female)
This means that the motivation to provide care during the pandemic was influenced by availability of personal protective equipment.
Adaptation to COVID 19:
During the interview many participants expressed fear as evidenced by participants who acknowledged the initial difficulty of caring for patients due to the fearsome nature of the pandemic but noted that with time, the process became more manageable. One participant cited trust in God and adherence to COVID-19 guidelines as their adaptation strategy, highlighting the importance of both faith and following established protocols. In a similar manner, others mentioned that witnessing patient recoveries instilled hope and contributed to their adaptation. The responses were:
“well it was difficult, because of people dying, it was fearsome to continue caring for
patients but after some time it was fine.” (F-29yrs-Female)
At first it was difficult but by trusting in God and adhering to covid-19 guidelines
(G-29yrs-Male)
“Initially it not easy, but seeing patients recover made me to have hope and by following
infection prevention measures and covid-19 protocol and guidelines” (K-29yrs-Female)
Many participants, initially expressed the difficulty of adapting to the challenges posed by the pandemic, such as fear. However, over time, there was a gradual adjustment and acceptance of the situation.
One participant shared a unique perspective, indicating a shift in adaptation from initial fear to acceptance after recovering from Covid-19. During the interview the participant said:
“At first it was not easy because of fear, then when I recovered after being diagnosed with
covid-19 I took it as any other condition.” (B-30yrs-Female)
It was cited that after recovering from COVID-19, they began viewing the condition as they would any other, demonstrating a resilient mindset and adaptability to the evolving situation.
Helping Patients Adapt:
Participants described addressing patient anxiety by providing information about COVID-19, explaining recovery stories, and encouraging patients to adhere to treatment procedures. The participants recognized the importance of instilling confidence and hope in patients.
“ Most patients had anxiety about the new disease and by giving them more information
about covid-19 and explaining to them about those who were sick and were discharged
gave them confidence and hope. And also encouraging them to obey all treatment
procedures.” (F-29yrs-F)
The participants' responses to the question on helping patients adapt to COVID-19 during their practices revealed a patient-centered approach, emphasizing communication, education, and psychological support.
Similarly, other participants emphasized counseling patients about their conditions, educating them on COVID-19 signs and symptoms, and advising on the importance of adhering to protective measures.
“counselling patients about their condition.” (G-29yrs-Male)
The participant's approach involved both informational and emotional support, illustrating a holistic strategy to help patients adapt to the challenges posed by the pandemic.
In contrast, one participant, who did not work in an isolation center, focused on providing counseling to relieve patient anxiety. Additionally, they highlighted the significance of offering education to patients, reinforcing preventive measures, and dispelling myths spread by the media.
“counselling patients about their condition to relieve anxiety and giving education to
patients” (I-28yrs-Female)
Participant MCHI's responses reflected a proactive effort to empower patients with knowledge and dispel misconceptions.
The challenges encountered by nurses while delivering patient care during the COVID-19 pandemic
The emerged themes under this study included, the challenges nurses face when delivering patient care, management of challenges and recommendations.
Patient Care Delivery challenges
Participants provided insights into the many challenges they encountered while delivering patient care during the COVID-19 pandemic. These challenges included, resource limitations, negative society reactions, environmental factors, diagnostic issues, and the overall impact on healthcare professionals.
A prominent theme in participants' responses was the shortage of critical resources. This included a lack of oxygen concentrators, personal protective equipment, and other essential supplies.
“Shortage of resources like oxygen concentrators and gas cylinders” (B-30yrs-Female)
“Lack of resources, most things were not available” (F-29yrs-Female)
“Resourced were limited for example lack of resources like oxygen, personal protective
equipment’s among others” (H-29yrs-Male)
“There was shortage of staff and that staff became exhausted because of working extra
hours” (K-29yrs-Female)
Participants in highlighting these shortages, emphasized the negative effects on patient care and the added stress it placed on healthcare workers.
Several participants shared experiences of discrimination and negative reactions from the community. Some participant faced isolation from the community, physical assaults, and discrimination.
“we were isolated from the community and we were not allowed to move and sometimes
we were beaten as well” (B-30yrs-Female)
“As nurses we were segregated not to come near to the community and were denied access
to public transport and at some point we could not wear uniform” (I-28yrs-Female)
Furthermore, one participant mentioned patients and guardians were denying the existence of COVID-19 during the first wave, accusing healthcare workers of intending to harm them.
“At first during first wave patients and guardians were not accepting that covid-19 was
real. They were saying they don’t have covid-19 and nurses want to kill them.”
(F-29yrs-Female)
All these highlighted reactions added emotional stress to an already challenging situation.
During the interview indicated the challenge of having limited space and dust accumulation due to the inability to clean adequately further highlighted the environmental constraints participants faced.
“Personal protective equipment’s was available, food was good, and sleeping environment
was good, however, the space was small to care for patients.” (K-29yrs-Female)
Environmental challenges were also brought to light. Participants noted that, despite having PPE and adequate food, the limited space in the treatment center posed challenges to effective patient care.
The issue of missed diagnoses and inadequate time for patient care emerged as significant challenges. Participants spoke about patients being misdiagnosed in screening areas.
“ As nurses we came in contact with the patients in the ward who were missed diagnosis
and only to realize that the patient had covid-19.” (B-30yrs-Female and E-31yrs-Male)
Additionally, Participants highlighted the difficulty of documenting care under time constraints.
“Documentation was also a challenge because we couldn’t carry papers to avoid
contaminating them with virus. Also walking in phases of 2–4 hours was not enough to
provide comprehensive care. sometimes it was difficult to monitor patient accordingly due
to shortage of staff and limited time.” (E-31yrs-Male)
The points that were raise indicated potential exposure for healthcare workers to Covid-19 and risk of incomplete data collection.
Communication challenges were also identified, the participants stated that there were communication challenges particularly in providing results to patients after testing positive and phone connectivity problems. The reported points were:
“Communication was poor to give results to patients after testing positive. Some patients
were sent home to wait for results and using phones to communicate to them was difficult
because phones were not connecting. Lack of information to the community about Covid-
19, as such it was hard for convince patients and guardian that covid-19 was real.”
(D-34yrs-Female)
According to the one participant, some patients were sent home to wait for results, and the use of phones for communication was hindered by connectivity issues. This added layer of difficulty highlighted the need for improvements in result communication strategies to enhance patient care delivery.
During the interview, some participants pointed out the challenge of finding people not willing to work, highlighting the broader issue of human resource scarcity. Some participants reported:
“ Human resource was a challenge due to shortage of staff and few people were willing to
work and attend to covid-19 patients.” (H-29yrs-Male)
A noteworthy addition to the challenges faced was the shortage of staff, compounded by a reluctance of individuals to attend to covid-19 patients.
Participants addressed the psychological impact on healthcare professionals. Fear, stress, and the lack of compensation for healthcare workers, even when diagnosed with COVID-19, were significant concerns. The highlighted points were:
“As nurses we were infected, had fears and stress because of covid-19”, We were not
compensated and if even when diagnosed with covid-19, we were asked to report for
work especially during third wave.”. “Guardians were saying we had the intention of
killing their relatives” (K-29yrs-Female)
The emotional toll on healthcare workers, especially during the third wave, where reporting to work even with a diagnosis was required, showcased the immense strain on the workers.
Management of challenges during COVID-19 Patient Care Delivery
Participants detailed different strategies and actions they took to address the challenges encountered while delivering patient care during the COVID-19 pandemic. These responses reflected the adaptability, resilience, and collaborative efforts of healthcare workers in managing the complex issues associated with the pandemic.
Collaborative efforts emerged as a recurring theme in the participants' responses. Many participants highlighted the importance of working as a team to support patients. Participants specifically mentioned the coordination of tasks among healthcare workers to ensure comprehensive patient care. Two participants indicated:
“ By working as, a team and giving each other time to care for the patient. for example,
nurses will do bed bath and feeding then after doctors will come to see the patients
progress.” (B-30yrs-Female)
“We continued to work as team to support patients” (K-29yrs-Female)
This collaborative approach was not only crucial in addressing resource shortages but also in managing the emotional and physical challenges associated with the pandemic.
Several participants took proactive measures to address resource shortages. One mentioned the active pursuit of resources, including personal protective equipment’s, medications, and gloves.
“We had to look for resources and have positive altitude by using available resources to
help patients” (F-29yrs-Female)
This resource mobilization was a practical response to the challenges posed by insufficient supplies, reflecting a solution-oriented approach to enhance patient care delivery.
Participants mentioned using history on admission, physical examination, and progress of the patient to evaluate care. One participant, described the allocation of specific beds for patients exhibiting signs and symptoms of COVID-19, illustrating a systematic approach to patient management within limited resources. This is shown below:
“Used history on admission, physical examination and progress of the patient to evaluate
care. double gloving so that you can remove the other pair and use the other for
documenting. Asking a friend to be documenting on your behalf.” (H-29yrs-Male)
Patients with signs and symptoms of covid-19 were given the back bay beds
(I-28yrs-Female)
In response to managing challenges related to patient care, participants employed strategies such as patient segregation based on symptoms and continuous monitoring.
Acknowledging the shortage of staff and the exhaustion experienced by healthcare workers, one highlighted the importance of ongoing training.
“Trainings about covid-19 should continue so that people are updated about covid-19
protocol and guide lines” (H-29yrs-Male)
Training sessions were seen as a means to equip healthcare workers with the necessary skills, ensuring effective patient care despite the challenges posed by staff limitations.
In this study, participants, some participants, emphasized the significance of communication with patients and their families, helping them understand the nature of the disease and fostering cooperation.
“During first wave patients could not understand about the new disease, but after
explaining to them and guardian they understood.” (B-30yrs-Female)
Effective communication played a crucial role in managing challenges, particularly in situations where healthcare workers were isolated or faced discrimination.
Documentation also emerged as a practical strategy. One mentioned documentation as a challenge as below:
“Documentation was also a challenge because we couldn’t carry papers to avoid
contaminating them with virus. Also walking in phases of 2–4 hours was not enough to
provide comprehensive care. sometimes it was difficult to monitor patient accordingly due
to shortage of staff and limited time” (E-31yrs-Male)
On the other hand, the same suggested a way to manage the problem as highlighted in the statement:
“Introduced to write on the papers and could paste it on the wall especially vitals sign and
document later in the files” (E-31yrs-Male)
Similarly, one participant noted the importance of documentation to keep patients record as highlighted below:
“Used history on admission, physical examination and progress of the patient to evaluate
care. double gloving so that you can remove the other pair and use the other for
documenting. Asking a friend to be documenting on your behalf.” (H-29yrs-Male)
This adaptive approach ensured that essential information about patient care was recorded, even in situations where time and resources were constrained.
Participants, including Participants highlighted the provision of psychological support to patients. This involved counseling, education, and encouragement to alleviate anxiety and fear associated with COVID-19. One indicated:
by giving them information about Covid-19 and giving them psychological support.
(A-40yrs-Female)
Addressing the psychological impact of the pandemic on both healthcare workers and patients was a key aspect of challenge management.
During the interview, participants emphasized the importance of maintaining sufficient stock of resources to address the demands of patient care effectively. The responders said:
“ Equipment’s should be readily available” (A-40yrs-Female)
Resources like PPEs, medications, gloves should be readily available
(F-29yrs-Female)
“To be ready in terms of resources, building infrastructures for isolation and all resources
needed should be readily available.” (H-29yrs-Male)
There should be enough equipment’s like oxygen cylinders should be readily available.
(K-29yrs-Female).
A consistent theme across participants' recommendations was the urgent need for an adequate supply of essential resources. This included ensuring the ready availability of equipment such as oxygen cylinders and personal protective equipment’s.
Participants emphasized the significance of consistent allowances for healthcare workers. The financial aspect was deemed crucial, with Participants highlighting the fluctuation in allowances during different waves of the pandemic. Participants said:
“Covid-19 allowance should be constant (fixed amount). For example, during first wave
allowance was high and then during second and third wave allowance decreased.”
(A-40yrs-Female).
“Allowance to be maintained and not changing but should be constant” (K-29yrs-
Female)
According to the reports there is a call for a constant and reliable allowance aimed to motivate healthcare workers and ensure financial stability, especially during challenging times.
As advocated by Participants, it was seen as essential for creating a conducive environment for patient care. This includes having enough space, monitors for each bed, and facilities designed to handle the specific challenges posed by infectious diseases.
“ To be ready in terms of resources, building infrastructures for isolation and all resources
needed should be readily available.” (H-29yrs-Male)
The same point of building infrastructures for creating a conducive environment to provide care was noted by another participant as below:
“The government and the hospital should reserve funding for epidemics and
construct in fractures ready for epidemics and not disturbing other essential services to
cater for other disease.” (B-30yrs-Female)
Several participants suggested improvements to healthcare infrastructure as a key recommendation. Constructing dedicated facilities for managing epidemics.
The participants emphasized the crucial role of the government in addressing and preventing epidemics. This is evident by one participant highlighting:
“The government after knowing or discovering the new epidemic should be the first to
information and not the media which sometimes spreads rumors.” (B-30yrs-Female)
Participants recommended ongoing training programs to keep healthcare workers updated on COVID-19 protocols and guidelines. This suggestion underscores the importance of investing in the professional development of healthcare workers to ensure a well-prepared and knowledgeable workforce.
“Trainings about covid-19 should continue so that people are updated about covid-19
protocol and guide lines” (H-29yrs-Male)
During the interview, the need for continuous training and support for healthcare staff was highlighted.
Several participants stressed the importance of community sensitization. Recommendations included raising awareness about COVID-19, dispelling myths, and educating the public on preventive measures. This aligns with the broader goal of fostering understanding and cooperation between healthcare workers and the community.
The significance of ongoing vaccination campaigns was emphasized. This was shown during the interview as evidenced by the respondent saying:
“Covid-19 vaccination should continue as some have not vaccinated.” (K-29yrs-Female)
This recommendation underlines the importance of maintaining and intensifying efforts to vaccinate populations, ensuring a higher level of immunity and potentially reducing the severity of future outbreaks.