Barriers and enablers experienced by the health-care providers in delivering health-care in specialized COVID-19 wards: A qualitative descriptive study from two tertiary care hospitals of India

Background/Objectives: The high incidence of COVID-19 in India has put an undue pressure on the healthcare providers (HCPs) posted in COVID-19 wards. The primary aim of this study was to explore the barriers and enablers of delivering health-care in specialized COVID-19 wards during the second COVID-19 wave in India.

Methods: The qualitative study was conducted in two tertiary-care hospitals of Lucknow and Pune cities, India. HCPs (physicians and nurses) posted in the hospitals were approached for data collection. Data was collected using `diaries` followed by `in-depth interviews (IDIs)`.HCPs were requested to document day-to-day barriers and/or enablers of delivering healthcare in COVID-19 wards for seven-days in diaries. After this, IDIs were conducted to co-create meaning with interviewees by reconstructing perceptions of events/experiences related to health-care delivery. Selection of respondents was purposive with maximum variation. Respondents were (a) Physicians: work-experience (senior faculty/resident/postgraduate-medical student), gender (b) Nurses: work-experience (< 5 or >5 years), work shift (night/day duty). IDIs were conducted till saturation. Thematic analysis was used to interpret data. Key themes were established based on emerging concepts.

Results: Between March-June 2021, qualitative data was collected from 16 nurses and 16 physicians posted in COVID-19 wards. Three distinct themes emerged: (a) `Occupational barriers` lack of training &/or refresher training before posting; moral/ethical dilemmas (self-care versus care of others, caring for all severely unwell patients within constrained resources) ; quality and completeness of PPE; misfitting PPEs and/or gloves; excessive reporting formalities (b) Phycological barriers: feeling of burnt out` because of prolonged working hours; unfeeling and impersonal response toward patients; sometimes feeling dissatisfied because of COVID-19 duty; difficult patient-provider communication (c) `Social Barriers` : Social stigma and high expectations from the society. Availability of PPE kit, support of the family/friends, solidarity and cooperation of colleagues and availability of seniors were perceived as enablers.

Discussion: Our research provides critical contextual data on the occupational, psychological and social barriers that negatively impact the job productivity of HCPs. Along with psycho-social stress, the HCPs face systemic-logistical barriers that may adversely affect service delivery and result in negative health-outcomes for COVID-19 patients. All these need to be addressed urgently.