Impact of Covid-19 on patient care delivery among nurses at Nzuzu Central Hospital, Northern Malawi

Abstract

Introduction: Covid-19, caused by the novel SARS-CoV-2, brought significant challenges to the health care delivery system. The pandemic impacted care delivery not only due to the severity of the disease and the high mortality rate but also because of its consequences on the management of patients. However, little is known about how Covid-19 affected patient care delivery, particularly in relation to the five major concepts highlighted in the Adaptation Model of Nursing: Person, Environment, Health, Nursing, and Adaptation. The aim of this study was to assess the impact of Covid-19 on patient care delivery among nurses at Mzuzu Central Hospital in northern Malawi. Methods: The study employed mixed methods, utilizing both quantitative and qualitative approaches. Analytical cross-sectional and phenomenological study design strategies were used. Purposive sampling targeted frontline nurse caregivers for qualitative data, while simple random sampling was used for quantitative data. Eleven participants were involved in qualitative interviews, and 208 nurses participated in the quantitative survey. Qualitative data were analyzed using NVivo for thematic analysis, while SPSS was used for quantitative analysis, including chi-square tests and logistic regression. Results: The study revealed enormous changes in patient care delivery due to Covid-19. Key challenges included lack of PPE (76.44%), exhaustion (76%), fear of infection (83.3%), and fear of seeking care (87%). Chi-square analysis identified significant associations with exhaustion (p = 0.004), fear of infection (p = 0.019), and resource scarcity (p = 0.0005). In the multivariate analysis, the adjusted Odds Ratios (aORs) were calculated to control for potential confounding factors. Some variables continued to demonstrate significant associations with compromised care delivery. This included exhaustion; (aOR = 1.984, 95% CI: 1.159-3.398 p= 0.014), fear of infection; (aOR = 1.778, 95% CI: 1.010-3.128 p= 0.045) and resource scarcity; (aOR = 2.349, 95% CI: 1.303- 4.230 p= 0.004), all of which remained significant predictors of compromised care delivery during the pandemic. Qualitative findings echoed these issues but also highlighted nurses' motivation driven by duty, patient recovery, and faith. Conclusion: The study concludes that Covid-19 significantly impacted on patient care delivery. Strengthening healthcare infrastructure, improving resources, and training are essential to enhance care quality and resilience during future health pandemic crises. Keywords: Mzuzu Central Hospital, Nurses, frontline, Covid-19, Impact, care delivery