A qualitative exploration of nurses’ and midwives’ experiences in designated COVID-19 healthcare facilities in rural and urban Tanzania

Abstract

Background: Frontline healthcare providers, particularly nurses and midwives, are at higher risk of COVID-19 infection due to frequent patient contact. However, studies examining their experiences, particularly in low-income countries like Tanzania, are limited.

Objective: This study aimed to explore the experiences of nurses and midwives providing care in COVID-19-designated healthcare facilities in selected regions of Tanzania.

Methods: A qualitative descriptive approach was used to investigate the experiences of nurses and midwives in COVID-19 care. In-depth interviews were conducted with 20 purposefully selected participants from Dar es Salaam, Shinyanga, and Pwani regions. Data were coded with NVivo 12 software and analyzed using a descriptive phenomenology approach.

Results: Nurses and midwives in urban areas reported managing more patients and experiencing more deaths than peers in rural settings. Urban and rural participants demonstrated strong knowledge of COVID-19, including its symptoms, management, and preventive measures. Selection for COVID-19 care was based on Ministry of Health guidelines, prioritizing leadership and emergency care experience. Their roles included patient isolation, routine and specialized care, psychological support, health education, and post-mortem care. Despite this, most nurses and midwives reported feeling underprepared due to insufficient training, a lack of personal protective equipment, and limited medical supplies. Additionally, no risk allowances were provided. Nurses and midwives experienced key challenges such as patient stigmatization, abandonment by families, deaths resulting from oxygen shortages, burnout, and personal infection. Nurses and midwives recommended strengthening the healthcare system, providing ongoing training, offering risk allowances, and promoting community education and sensitization to improve future pandemic preparedness.

Conclusion: Nurses' and midwives' experiences in COVID-19 care facilities were surrounded by inadequate preparations, with health system deficiencies and societal fears significantly impacting their ability to provide effective care. Strengthening health sector readiness, including training and resource allocation, is essential for future pandemic and disaster response efforts.