Title : Challenges in implementing infection prevention and control guidelines among nurses during the COVID-19 pandemic: Insights from Nepal
Abstract:
Introduction: Effective infection prevention and control (IPC) programs can significantly reduce healthcare-associated infections by up to 70%. However, a global disparity exists in meeting minimum IPC requirements, with high-income countries over eight times more likely to have IPC implementation status than low-income countries. This study explored Nepalese nurses' experiences implementing IPC guidelines during COVID-19 in Nepal, examining barriers, facilitators, and lessons for future implementation.
Methods: This study employed a qualitative research design, focusing on Nepali-speaking registered nurses in Nepal's secondary or tertiary care hospitals. Grounded in the Theoretical Domains Framework (TDF), 12 participants were selected using purposive sampling. Semi-structured online interviews were conducted in the Nepali language via Microsoft Teams. Data analysis was guided by thematic analysis. To ensure data rigour, a professional translator facilitated the translation of concepts, categories, and emerging themes from Nepali to English.
Results: Seven main themes emerged regarding nurses' experiences with COVID-19 IPC guideline implementation: i) Initial challenges and resistance to change, ii) Changes and evolution in IPC practices, iii) Psychological resilience and emotional Impact, iv) Organisational dynamics and adaptation, v) Practical issues and procedural challenges, vi) Ethical considerations and cultural nuances in IPC, vii) Never-ending learning and improvement saga. Barriers were categorised into six themes: i) Evolving IPC Guidelines and knowledge, ii) Attitudes and beliefs, iii) Organisational challenges, iv) Psychological and emotional barriers, v) Environmental and structural challenges, and vi) Social and external factors. Facilitators included: i) Experience and knowledge, ii) IPC Team and collaboration, iii) Safety and professional obligations, iv) Support and guidance, v) Trust and motivation, vi) Teamwork, collaboration, and adaptation. The TDF domains influencing nurses' IPC guideline implementation behaviour included Knowledge, Beliefs about consequences, Environmental context and resources, Social influences, and Emotion.
Discussion: Nurses implementing COVID-19 IPC guidelines exhibited adaptability and resilience, navigating initial challenges through evolving practices. In Nepal, targeted interventions addressing knowledge disparities, fostering organisational support, and prioritising mental well-being are recommended to implement IPC guidelines effectively.
