The participants of this study were twenty-four, Twelve of them from the third year and the others from fourth-year nursing students. Concerning the gender of the participants, sixteen of them were males whereas eight of them were females. The age of study subjects ranged from 21-28 with a median age of 23. After analysis of the data, four main themes and twelve subthemes of the challenges were extracted. The main themes of this study were; Risks to contracting COVID-19, negative impact on health care, worry, and loss of experienced staff as shown in Table 1.
Table 1
The extracted main themes and subthemes
S.no | Main Themes | Subthemes |
1 | Risk to contracting COVID-19 | a. contact with many patients b. poor disinfection practice c. negligence |
2 | Negative impact on health care, | a. altered patient–care provider relation b. interruption of practical education c. shortage of medical equipment |
3 | Worry | a. fear of getting the disease b. detachment of friendship relation with other students c. negative attitude towards the profession |
4 | loss of experienced staff | a. quarantining of health care workers b. COVID-19 related death of health care providers c. establishment of COVID-19 treatment center |
The risks to contracting COVID-19 disease
The participants of this study mentioned during FGD that there were favorable conditions for the spread of COVID-19 in the clinical care setting. All participants of this study emphasized on high risks of getting COVID-19 disease during clinical practices. This is due to contact with many patients, poor disinfection practices, and negligence of the students.
Contacting with many patients
Learning a skill is by doing. The students make contact with many patients during clinical practice like taking vital signs, conduct certain procedures, and carried out a physical examination. This contact or closeness favors the transmission of COVID-19. The majority of the patients admitted to the hospital come from rural areas where the prevention of COVID-19 was very poor, even the existence of disease itself was not believed by the population. On other hand, proper screenings of the patients were not done before admission. In this regard, one student said as follow;
“There was a female patient admitted to the medical ward with other medical conditions. She was my patient and I provide care to her for three days. Unfortunately, before the result of the lab investigation was reached, the patient passed away. Upon reaching of lab result, the finding was positive for COVID-19 virus.” (Male participant from fourth-year nursing)
Poor disinfection practice
To prevent the spread of COVID-19, disinfection of medical equipment and the ward surfaces is important. However, in the study setting, there were poor disinfecting practices carried out.
“… medical equipment such as; BP apparatus, thermometers, pulse ox meter, etc were used without disinfecting between the patients…” (Female participant from third-year nursing)
Negligence
Some students were reluctant to the COVID-19 prevention protocol. Unless they emphasized the protocol, they were easily susceptible to COVID-19.
“Some students were consciously broke the COVID-19 prevention protocol during their clinical attachment at health care setup.” (Male participant from Fourth-year nursing)
Negative impact on the health care
Generally, all participants of this study agreed on the service provided by the health care facility was disturbed due to the COVID-19 pandemic.
Altered patient-care provider relation
To provide quality care, good patient-care provider relation was crucial. However, after the rise of the COVID-19 pandemic, patient-care provider relations were affected. All participants of FGD agreed patient care-provider interaction was negatively affected.
“Due to fear of getting COVID-19 diseases, health care providers are far away from the patients. Particularly, patients with respiratory cases. As a result, health care workers do not get deep information about patients. These lead to patient’s treatment error.” (Female participant from Fourth-year nursing)
"Because of COVID-19 cases found in the hospital, I suspect all cases and far away from them. I am not vaccinated against COVID-19virus. For this reason, I prefer to be a distance from the patient despite I am here to learn the clinical skill by doing." (Male participant from Fourth-year nursing)
Interruption of practical education
As understood from participants of the FGD discussion, the raise of the COVID-19 pandemic leads to the interruption of practical education. The closing of education is to minimize the spread of COVID-19. On this issue, one student says;
“If the epidemic raises, this hospital may come treatment center to provide services for COVID-19 cases. At this time, the hospital may not give another service including clinical learning skill.” (Male participant from third-year nursing)
Shortage of medical equipment
COVID-19 cases treated at the treatment center, treatment center needs additional medical equipment to give full function. This leads to a shortage of medical supplies.
“If COVID-19 cases raise, there is increasing case flow that uses many medical equipments such as advanced life support equipment, other basic life support, personal protective equipment, and beds. Inadequacy of that equipment in a health care setting is also another challenge." (Male participant from fourth-year nursing)
Worry
All students participate in FGD agreed on psychological distress was the common challenge that faced them. This is due to fear of getting the disease and transmission to their family members, fear of stigma and isolation, fear from inadequate PPE, and the low-quality PPE they used.
Fear of getting the disease
As COVID-19 spreads easily through the aerosol droplet, contact with patients and equipment that has the virus, there is a high probability of being infected with the virus. As a result, all participants of this study were afraid of getting the COVID-19. In this regard, one student mentioned the following;
“I am a chronic asthmatic patient that makes me vulnerable to negative consequences of COVID-19. For this reason, I am in suspicion of getting the disease and died from my family and transmit the disease to other people." (Male participant from fourth-year nursing)
Detachment of friendship relation with other students
Participants FGD discussed the student's interaction affected if they were infected with the COVID-19 virus. There may probability of being far away from one another if one of their members is infected with the virus.
“Clinical practical learning involves learning team. Learning a skill is better if it is in the team from one another to be competent. However, if one of the team members is infected, we will not work to gather as a team rather afraid of one another.” (Female participant from third-year nursing
Negative attitude towards the profession
Some participants of this study reported that COVID-19 leads to a negative attitude towards the nursing profession as one role of nurses in direct patient care and contact with patients for a longer time.
“If student nurse infected with COVID-19, it is difficult to like the profession because the aim of the nurse is to provide care to the patients and remain healthy for themselves. On the other hand, if they infected while giving care to others, really this disappointing.” (Male participant from third-year nursing)
Loss of experienced staff
Health care providers infected with COVID-19 than other segments of the population. Doctors, nurses, and other health care professionals also quarantined, died due to COVID-19. This leads to the shortage of knowledgeable health care workforces in health care facilities.
Quarantining of health care workers
Quarantining suspected or infected health care workers with COVID-19 into the treatment center was mandatory. Suspected or infected health care workers were not continued care and even in quarantine centers, they stayed around two weeks. For this reason, the number of frontline health care workers reduced. One participant said the following;
“…if the number of health care professional quarantined, there may be a shortage of active health working force…” (Male participant from third-year nursing)
COVID-19 related death of health care providers
The death of health care workers due to COVID-19 became increasing. Comparing with the general population, death due to COVID-19 among health care providers was far superior. This is a great problem for Sub-Saharan Africa where healthcare manpower is below world health organization standards even before the occurrence of the pandemic. Concerning this issue, one study participant describes it as follow;
"…if CIVID-19 cases raise, vulnerable health care workers those have a chronic illness and who were older age may be involved in patient care. These groups of health care professionals risk groups to the negative outcome of COVID-19 diseases." (Male participant from fourth-year nursing)
Establishment of treatment center
COVID-19 confirmed cases isolated or treated may be newly established treatment centers. The treatment center needs adequate health care professionals to give quality care. This brings critical challenges to a country with low health care manpower. Regarding this issue, one student said the following;
“If covid-19 cases to raises, many treatment centers may be stabled or previously multi-purpose hospitals shifted to provide care to covid-19 cases. The requirements of health care workers increase at the time. Therefore, establishing treatment centers for covid-19 cases leads to scarcity of health care man power in general.” (Male participant from third-year nursing)