Experiences and Perceptions of Non-intensive Care Trained Nurses in Caring for Patients on Mechanical Ventilators in Mahalapye District Hospital, Botswana
Article Sidebar
Main Article Content
Abstract
Background: There is an increasing patient acuity in Intensive Care Units (ICUs) in Botswana, with a growing demand for mechanical ventilation. As a result, non-intensive care-trained nurses are increasingly being involved in the care of patients on mechanical ventilators in the ICUs. There is limited research on non-intensive care trained nurses’ experiences and perceptions in caring for patients on mechanical ventilation in Botswana, yet they play a significant role in the care of ventilated patients. This poses a gap in understanding the specific experiences and perceptions of these nurses in their roles in providing care for patients on mechanical ventilators.
Aim: To explore the experiences and perceptions of non-intensive care trained nurses caring for patients on mechanical ventilators in Mahalapye District Hospital in Botswana.
Method: A qualitative, descriptive phenomenological design was used in this study. The researcher purposively selected eight non-intensive trained nurses who had cared for patients on mechanical ventilators for at least one year. Data was collected through face-to-face interviews, transcribed verbatim, and analysed using thematic analysis.
Findings: Five major themes emerged from this study. Theme one, emotional burden and exhaustion in caring for patients on mechanical ventilators, Theme two, perceived lack of knowledge and skills, and learning on the job. Theme three is resource and organisational challenges, while theme four is support and teamwork in ventilated patient care delivery. Theme five is positive perceptions of caring for ventilated patients and professional fulfilment.
Conclusion: Non-intensive care-trained nurses face challenges in caring for mechanically ventilated patients, including emotional distress, knowledge gaps, and resource limitations. Addressing these issues through targeted training, emotional support programmes and improved resource allocation is essential to enhancing the quality of nursing care for ventilated patients and could improve patient outcomes.
Article Details
Copyright (c) 2025 Bohutsana G, et al.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Sweity EM, Salahat AM, Sada AA, Aswad A, Zabin LM, Zyoud SH. Knowledge, attitude, practice and perceived barriers of nurses working in intensive care unit on pain management of critically ill patients: a cross-sectional study. BMC Nurs. 2022;21(1):202. Available from: https://doi.org/10.1186/s12912-022-00990-3
Hassen KA, Nemera MA, Aniley AW, Olani AB, Bedane SG. Knowledge regarding mechanical ventilation and practice of ventilatory care among nurses working in intensive care units in selected governmental hospitals in Addis Ababa, Ethiopia: a descriptive cross-sectional study. Crit Care Res Pract. 2023;2023:4977612. Available from: https://doi.org/10.1155/2023/4977612
Namadian M, Taran Z. The effect of sedation protocol on sedation level and pharmacological and non-pharmacological interventions on mechanically ventilated patients. Iran J Nurs Midwifery Res. 2021;26(4):316-323. Available from: https://doi.org/10.4103/ijnmr.ijnmr_165_20
Guilhermino MC, Inder KJ, Sundin D. Education on invasive mechanical ventilation involving intensive care nurses: a systematic review. Nurs Crit Care. 2018;23(5):245-255. Available from: https://doi.org/10.1111/nicc.12346
Hassen KA, Nemera MA, Aniley AW, Olani AB, Bedane SG. Knowledge regarding mechanical ventilation and practice of ventilatory care among nurses working in intensive care units in selected governmental hospitals in Addis Ababa, Ethiopia: a descriptive cross-sectional study. Crit Care Res Pract. 2023;2023:1-8. Available from: https://doi.org/10.1155/2023/4977612
Chamberlain D, Pollock W, Fulbrook P. ACCCN workforce standards for intensive care nursing: systematic and evidence review, development, and appraisal. Aust Crit Care. 2018;31(5):292-302. Available from: https://doi.org/10.1016/j.aucc.2017.08.007
Sharma S, Rani R. Nurse-to-patient ratio and nurse staffing norms for hospitals in India: a critical analysis of national benchmarks. J Fam Med Prim Care. 2020;9(6):2631. Available from: https://doi.org/10.4103/jfmpc.jfmpc_248_20
Nakweenda M, Anthonie R, Van Der Heever M. Staff shortages in critical care units: critical care nurses experiences. Int J Afr Nurs Sci. 2022;17:100412. Available from: https://doi.org/10.1016/j.ijans.2022.100412
Babazadeh M, Jahani S, Poursangbor T, Cheraghian B. Perceived barriers to early mobilization of intensive care unit patients by nurses in hospitals affiliated to Jundishapur University of Medical Sciences of Ahvaz in 2019. J Med Life. 2021;14(1):100-104. Available from: https://doi.org/10.25122/jml-2019-0135
Khan N, Jackson D, Stayt L, Walthall H. Factors influencing nurses’ intentions to leave adult critical care settings. Nurs Crit Care. 2019;24(1):24-32. Available from: https://doi.org/10.1111/nicc.12348
Squires A, Jylhä V, Jun J, Ensio A, Kinnunen J. A scoping review of nursing workforce planning and forecasting research. J Nurs Manag. 2017;25(8):587-596. Available from: https://doi.org/10.1111/jonm.12510
Atumanya P, Sendagire C, Wabule A, Mukisa J, Ssemogerere L, Kwizera A. Assessment of the current capacity of intensive care units in Uganda: a descriptive study. J Crit Care. 2020;55:95-99. Available from: https://doi.org/10.1016/j.jcrc.2019.10.019
Crawford AM, Shiferaw AA, Ntambwe P, Milan AO, Khalid K, Rubio R, et al. Global critical care: a call to action. Crit Care. 2023;27(1):28. Available from: https://doi.org/10.1186/s13054-022-04296-3
Bvumbwe T, Mtshali N. Nursing education challenges and solutions in Sub Saharan Africa: an integrative review. BMC Nurs. 2018;17(1):3. Available from: https://doi.org/10.1186/s12912-018-0272-4
Maddumage ME, Gunasekara AYA, Priyankara WDD. Endotracheal tube cuff pressure management in adult critical care units in the National Hospital of Sri Lanka: a baseline audit. Sri Lankan J Anaesthesiol. 2017;25(1):31. Available from: https://slja.sljol.info/articles/10.4038/slja.v25i1.8199
Milan AO, Cox M, Molebatsi K. Results from the first audit of an intensive care unit in Botswana. South Afr J Crit Care. 2020;36(1):23. Available from: https://doi.org/10.7196/sajcc.2020.v36i1.395
Gundo R. Contextual issues that influence preparedness of nurses for critical care nursing practice in Malawi. Malawi Med J. 2019;31(2):138. Available from: https://doi.org/10.4314/mmj.v31i2.6
Mantovan F, Muzzana C, Schubert M, Ausserhofer D. It’s about how we do it, not if we do it: nurses’ experiences with implicit rationing of nursing care in acute care hospitals: a descriptive qualitative study. Int J Nurs Stud. 2020;109:103688. Available from: https://doi.org/10.1016/j.ijnurstu.2020.103688
Akroute AR, Brinchmann BS, Hovland A, Fredriksen STD. ICU nurses’ lived experience of caring for adult patients with a tracheostomy in ICU: a phenomenological-hermeneutic study. BMC Nurs. 2022;21(1):214. Available from: https://doi.org/10.1186/s12912-022-01005-x
Olorunfemi O, Nwozichi CU, Anokwuru RA. Lived experience of nurses caring for critically ill patients sustained by healthcare technologies in Benin-City, Nigeria. Int J Afr Nurs Sci. 2024;20:100679. Available from: https://doi.org/10.1016/j.ijans.2024.100679
Limbu S, Kongsuwan W, Yodchai K. Lived experiences of intensive care nurses in caring for critically ill patients. Nurs Crit Care. 2019;24(1):9-14. Available from: https://doi.org/10.1111/nicc.12349
Mukuve P, Nuuyoma V. Critical care nursing in a resource-constrained setting: a qualitative study of critical care nurses’ experiences caring for patients on mechanical ventilation. SAGE Open Nurs. 2023;9. Available from: https://doi.org/10.1177/23779608231205691
Neubauer BE, Witkop CT, Varpio L. How phenomenology can help us learn from the experiences of others. Perspect Med Educ. 2019;8(2):90-97. Available from: https://doi.org/10.1007/s40037-019-0509-2
Kaba E, Stavropoulou A, Kelesi M, Triantafyllou A, Goula A, Fasoi G. Ten key steps to writing a protocol for a qualitative research study: a guide for nurses and health professionals. Glob J Health Sci. 2021;13(6):58. Available from: https://www.semanticscholar.org/paper/Ten-Key-Steps-to-Writing-a-Protocol-for-a-Research-Kaba-Stavropoulou/2cb663689c84ba5f5c7305499fc58d0247f77205
Campbell S, Greenwood M, Prior S, Shearer T, Walkem K, Young S, et al. Purposive sampling: complex or simple? Research case examples. J Res Nurs. 2020;25(8):652-661. Available from: https://doi.org/10.1177/1744987120927206
Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant. 2018;52(4):1893-1907. Available from: https://doi.org/10.1007/s11135-017-0574-8
Sandelowski M. Sample size in qualitative research. Res Nurs Health. 1995;18(2):179-183. Available from: https://doi.org/10.1002/nur.4770180211
Moser A, Korstjens I. Series: practical guidance to qualitative research. Part 3: sampling, data collection and analysis. Eur J Gen Pract. 2018;24(1):9-18. Available from: https://doi.org/10.1080/13814788.2017.1375091
Lincoln YS, Guba EG, Pilotta JJ. Naturalistic inquiry. Int J Intercult Relat. 1985;9(4):438-439. Available from: https://www.scirp.org/reference/referencespapers?referenceid=3816731
Megheirkouni M, Moir J. Simple but effective criteria: rethinking excellent qualitative research. Qual Rep [Internet]. 2023 [cited 2024 Apr 28]. Available from: https://nsuworks.nova.edu/tqr/vol28/iss3/11/
Rana J, Dilshad S, Ahsan A. Ethical issues in research. In: Farazmand A, editor. Global encyclopedia of public administration, public policy, and governance [Internet]. Cham: Springer International Publishing; 2022 [cited 2024 Jul 3];4157-4163. Available from: https://link.springer.com/rwe/10.1007/978-3-030-66252-3_462
Alhamad N, Elsayed W. Nursing knowledge and preventive practices of ventilator-associated pneumonia as perceived by intensive care nurses in Hail City, KSA. Evid Based Nurs Res. 2024;6(4):1-11. Available from: https://eepublisher.com/index.php/ebnr/article/view/342
Getahun AB, Belsti Y, Getnet M, Bitew DA, Gela YY, Belay DG, et al. Knowledge of intensive care nurses towards prevention of ventilator-associated pneumonia in North West Ethiopia referral hospitals, 2021: a multicenter, cross-sectional study. Ann Med Surg [Internet]. 2022 [cited 2025 Feb 6];78. Available from: https://doi.org/10.1016/j.amsu.2022.103895
Abou Hashish EA, Alsayed S. Evidence-based practice and its relationship to quality improvement: a cross-sectional study among Egyptian nurses. Open Nurs J. 2020;14(1):254-262. Available from: http://dx.doi.org/10.2174/1874434602014010254
Elhabashy S, Moriyama M, Mahmoud EIED, Eysa B. Effect of evidence-based nursing practices training programme on the competency of nurses caring for mechanically ventilated patients: a randomised controlled trial. BMC Nurs. 2024;23(1):225. Available from: https://doi.org/10.1186/s12912-024-01869-1
Cheng J, Cui J, Yu W, Kang H, Tian Y, Jiang X. Factors influencing nurses’ behavioral intention toward caring for COVID-19 patients on mechanical ventilation: a cross-sectional study. PLOS ONE. 2021;16(11):e0259658. Available from: https://doi.org/10.1371/journal.pone.0259658
Shibiru S, Aschalew Z, Kassa M, Bante A, Mersha A. Clinical competence of nurses and the associated factors in public hospitals of Gamo Zone, Southern Ethiopia: a cross-sectional study. Nurs Res Pract. 2023;2023:1-11. Available from: https://doi.org/10.1155/2023/9656636
Lee J, Kang SJ. Factors influencing nurses’ intention to care for patients with emerging infectious diseases: application of the theory of planned behavior. Nurs Health Sci. 2020;22(1):82-90. Available from: https://doi.org/10.1111/nhs.12652
Al-Rjoub SF, Diener E, AL-Fayyadh S. Nurse administrators as the cause of moral distress among nurse educators: a qualitative research study. J Prof Nurs. 2022;43:117-123. Available from: https://doi.org/10.1016/j.profnurs.2022.09.007
Woo T, Ho R, Tang A, Tam W. Global prevalence of burnout symptoms among nurses: a systematic review and meta-analysis. J Psychiatr Res. 2020;123:9-20. Available from: https://doi.org/10.1016/j.jpsychires.2019.12.015
Torre M, Santos Popper MC, Bergesio A. Burnout prevalence in intensive care nurses in Argentina. Enferm Intensiva Engl Ed. 2019;30(3):108-115. Available from: https://doi.org/10.1016/j.enfi.2018.04.005
Galanis P, Moisoglou I, Katsiroumpa A, Vraka I, Siskou O, Konstantakopoulou O, et al. Increased job burnout and reduced job satisfaction for nurses compared to other healthcare workers after the COVID-19 pandemic. Nurs Rep. 2023;13(3):1090-1100. Available from: https://doi.org/10.3390/nursrep13030095
Lasater KB, Aiken LH, Sloane DM, French R, Martin B, Reneau K, et al. Chronic hospital nurse understaffing meets COVID-19: an observational study. BMJ Qual Saf. 2021;30(8):639-647. Available from: https://doi.org/10.1136/bmjqs-2020-011512
Turan N, Ançel G. Examination of the psychological changes in nurses due to workload in an intensive care unit: a mixed method study. Contemp Nurse. 2020;56(2):171-184. Available from: https://doi.org/10.1080/10376178.2020.1782762
Alrabae YMA, Aboshaiqah AE, Tumala RB. The association between self-reported workload and perceptions of patient safety culture: a study of intensive care unit nurses. J Clin Nurs. 2021;30(7-8):1003-1017. Available from: https://doi.org/10.1111/jocn.15646
Aprilia TD, Somantri I, Mirwanti R. Beban kerja mental perawat ruang kritis dan IGD di RSUD Kota Bandung. J Nurs Care [Internet]. 2019 Jul 7 [cited 2025 Feb 7];2(3).
Banda Z, Simbota M, Mula C. Nurses’ perceptions on the effects of high nursing workload on patient care in an intensive care unit of a referral hospital in Malawi: a qualitative study. BMC Nurs. 2022;21(1):136. Available from: https://doi.org/10.24198/jnc.v2i3.20372
Munyanziza T, Bhengu B, Umutoni Cishahayo E, Uwase A. Workplace stressors and coping strategies of intensive care unit nurses at university teaching hospitals in Rwanda. Rwanda J Med Health Sci. 2021;4(1):53-71. Available from: https://doi.org/10.4314/rjmhs.v4i1.5
Bolado GN, Ataro BA, Gadabo CK, Ayana AS, Kebamo TE, Minuta WM. Stress level and associated factors among nurses working in the critical care unit and emergency rooms at comprehensive specialized hospitals in Southern Ethiopia, 2023: explanatory sequential mixed-method study. BMC Nurs. 2024;23(1):341. Available from: https://doi.org/10.1186/s12912-024-02004-w
Zeb A. Nurses’ knowledge regarding prevention of ventilator associated pneumonia. Lupine Online J Nurs Health Care [Internet]. 2018 Nov 27 [cited 2025 Feb 6];2(1). Available from: https://lupinepublishers.com/nursing-journal/fulltext/nurses-knowledge-regarding-prevention-of-ventilator-associated-pneumonia.ID.000129.php
Sreenivasan V, Ganganna A, Rajashekaraiah P. Awareness among intensive care nurses regarding oral care in critically ill patients. J Indian Soc Periodontol. 2018;22(6):541. Available from: https://doi.org/10.4103/jisp.jisp_30_18
Gordon JM, Magbee T, Yoder LH. The experiences of critical care nurses caring for patients with COVID-19 during the 2020 pandemic: a qualitative study. Appl Nurs Res. 2021;59:151418. Available from: https://doi.org/10.1016/j.apnr.2021.151418
Yousif SY, AL-Fayyadh S. Burnout among nurses in critical care units: addressing a persistent challenge. Malays J Nurs. 2024;16(2):97-107. Available from: https://doi.org/10.31674/mjn.2024.v16i02.010
Dijxhoorn AFQ, Brom L, Van Der Linden YM, Leget C, Raijmakers NJ. Healthcare professionals’ work-related stress in palliative care: a cross-sectional survey. J Pain Symptom Manage. 2021;62(3):e38-e45. Available from: https://doi.org/10.1016/j.jpainsymman.2021.04.004
Lima A, Moreira MT, Fernandes C, Ferreira MS, Ferreira M, Teixeira J, et al. The burnout of nurses in intensive care units and the impact of the SARS-CoV-2 pandemic: a scoping review. Nurs Rep. 2023;13(1):230-242. Available from: https://www.mdpi.com/2039-4403/13/1/22
Yoo HJ, Lim OB, Shim JL. Critical care nurses’ communication experiences with patients and families in an intensive care unit: a qualitative study. PLOS ONE. 2020;15(7):e0235694. Available from: https://doi.org/10.1371/journal.pone.0235694
Lalithabai DS, Ammar WM, Alghamdi KS, Aboshaiqah AE. Using action research to evaluate a nursing orientation program in a multicultural acute healthcare setting. Int J Nurs Sci. 2021;8(2):181-189. Available from: https://doi.org/10.1016/j.ijnss.2021.01.002
Pertiwi RI, Hariyati RrTS. Effective orientation programs for new graduate nurses: a systematic review. Enferm Clin. 2019;29:612-618. Available from: https://www.researchgate.net/publication/334407955_Effective_orientation_programs_for_new_graduate_nurses_A_systematic_review
Caronia L, Saglietti M. Knowledge and agency in interprofessional care: how nurses contribute to the case-construction in an intensive care unit. J Interprof Care. 2018;32(5):592-602. Available from: https://doi.org/10.1080/13561820.2018.1463199
Seam N, Lee AJ, Vennero M, Emlet L. Simulation training in the ICU. Chest. 2019;156(6):1223-1233. Available from: https://doi.org/10.1016/j.chest.2019.07.011
Alharbi H, Alshehry A. Perceived stress and coping strategies among ICU nurses in government tertiary hospitals in Saudi Arabia: a cross-sectional study. Ann Saudi Med. 2019;39(1):48-55. Available from: https://doi.org/10.5144/0256-4947.2019.48
Vahedian-Azimi A, Hajiesmaeili M, Kangasniemi M, Fornés-Vives J, Hunsucker RL, Rahimibashar F, et al. Effects of stress on critical care nurses: a national cross-sectional study. J Intensive Care Med. 2019;34(4):311-322. Available from: https://doi.org/10.1177/0885066617696853
Darawad MW, Abu Feddeh S, Saleh AM. Factors affecting the caring performance of newly graduated nurses working in critical care units. Int J Nurs Pract. 2022;28(2):e13047. Available from: https://doi.org/10.1111/ijn.13047
Yoon HJ. The effect of nurse staffing on patient outcomes in acute care hospitals in Korea. Int J Environ Res Public Health. 2022;19(23):15566. Available from: https://doi.org/10.1111/ijn.13047
Al-Faouri I, Obaidat DM, AbuAlRub RF. Missed nursing care, staffing levels, job satisfaction, and intent to leave among Jordanian nurses. Nurs Forum (Auckl). 2021;56(2):273-283. Available from: https://doi.org/10.1111/nuf.12537
Park SH, Hanchett M, Ma C. Practice environment characteristics associated with missed nursing care. J Nurs Scholarsh. 2018;50(6):722-730. Available from: https://doi.org/10.1111/jnu.12434
Smith JG, Morin KH, Wallace LE, Lake ET. Association of the nurse work environment, collective efficacy, and missed care. West J Nurs Res. 2018;40(6):779-798. Available from: https://doi.org/10.1177/0193945917734159
Mousazadeh S, Yektatalab S, Momennasab M, Parvizy S. Job satisfaction and related factors among Iranian intensive care unit nurses. BMC Res Notes. 2018;11(1):823. Available from: https://doi.org/10.1186/s13104-018-3913-5
Kakemam E, Gharaee H, Rajabi MR, Nadernejad M, Khakdel Z, Raeissi P, et al. Nurses’ perception of patient safety culture and its relationship with adverse events: a national questionnaire survey in Iran. BMC Nurs. 2021;20(1):60. Available from: https://doi.org/10.1186/s12912-021-00571-w
Nantsupawat A, Poghosyan L, Wichaikhum O, Kunaviktikul W, Fang Y, Kueakomoldej S, et al. Nurse staffing, missed care, quality of care and adverse events: a cross-sectional study. J Nurs Manag. 2022;30(2):447-454. Available from: https://doi.org/10.1111/jonm.13501
Lake ET, Riman KA, Sloane DM. Improved work environments and staffing lead to less missed nursing care: a panel study. J Nurs Manag. 2020;28(8):2157-2165. Available from: https://doi.org/10.1111/jonm.12970
Kelly LA, Gee PM, Butler RJ. Impact of nurse burnout on organizational and position turnover. Nurs Outlook. 2021 Jan;69(1):96-102. Available from: https://doi.org/10.1016/j.outlook.2020.06.008
Mousazadeh S, Yektatalab S, Momennasab M, Parvizy S. Job satisfaction challenges of nurses in the intensive care unit: a qualitative study. Risk Manag Healthc Policy. 2019;12:233-242. Available from: https://doi.org/10.2147/rmhp.s218112
Baek H, Han K, Cho H, Ju J. Nursing teamwork is essential in promoting patient-centered care: a cross-sectional study. BMC Nurs. 2023;22(1):433. Available from: https://doi.org/10.1186/s12912-023-01592-3
Zeleníková R, Jarošová D, Plevová I, Janíková E. Nurses’ perceptions of professional practice environment and its relation to missed nursing care and nurse satisfaction. Int J Environ Res Public Health. 2020;17(11):3805. Available from: https://doi.org/10.3390/ijerph17113805
Kjällquist-Petrisi A, Hommel A. Preceptors’ experiences of peer learning in an intensive care unit. Nurse Educ Pract. 2021;54:103086. Available from: https://doi.org/10.1016/j.nepr.2021.103086
Carvello M, Zanotti F, Rubbi I, Bacchetti S, Artioli G, Bonacaro A. Peer-support: a coping strategy for nurses working at the emergency ambulance service. Acta Bio Medica Atenei Parm. 2019;90(11-S):29-37. Available from: https://doi.org/10.23750/abm.v90i11-s.8923
Friganović A, Selič P. Where to look for a remedy? Burnout syndrome and its associations with coping and job satisfaction in critical care nurses: a cross-sectional study. Int J Environ Res Public Health. 2021;18(8):4390. Available from: https://doi.org/10.3390/ijerph18084390
Salameh B, Abdallah J, Alkubati SA, ALBashtawy M. Alarm fatigue and perceived stress among critical care nurses in the intensive care units: Palestinian perspectives. BMC Nurs. 2024;23(1):261. Available from: https://doi.org/10.1186/s12912-024-01897-x
Rivaz M. Adequate resources as essential component in the nursing practice environment: a qualitative study. J Clin Diagn Res [Internet]. 2017 [cited 2025 Feb 6]. Available from: http://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&volume=11&issue=6&page=IC01&issn=0973-709x&id=9986
Bäcklund K, Persson K, Hadziabdic E. Intensive care nurses’ experiences of caring for intubated patients under light sedation: a qualitative study. Open J Nurs. 2018;8(7):473-484. Available from: https://www.scirp.org/journal/paperinformation?paperid=86138
Alhakami IY. Exploring the factors influencing nurse’s work motivation. Iris J Nurs Care [Internet]. 2018 [cited 2025 May 8];1(1). Available from: https://irispublishers.com/ijnc/fulltext/exploring-the-factors-influencing-nurses-work-motivation.ID.000503.php
Thapa M, Shrestha P, Pradhan GM, Khadka K. Intrinsic motivation and job performance in health institutions: nurse perspectives. J Bus Manag Inf Syst. 2025;12(1):1-10. Available from: https://qtanalytics.in/journals/index.php/JBMIS/article/view/4873