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Table 1 Showing study results

From: 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

Themes

Findings

Supporting Quotes

Care compromised

Nurses are unable to provide maximum quality care and leave care activities not considered priority undone

“We only prioritize some things; leaving the other things not done. Its better I do this and that…You can’t turn the patient because you have to run and check the other patient, it means you have left out the turning which is very important. And you can’t feed in time because you have to check if Airway Breathing and Circulation is okay on the other bed. I can abandon things like turning, feeding, mouth care, changing patients’ soiled linen; Because those are the things that I can do later” (Participant 6, NMT)

Compromised patient safety

Nurses perceived that the safety of ICU patients is compromised due to the high nursing workload experienced

Nurses at times prepare the wrong medication when they are tired and exhausted

“At some point they are not safe, frankly speaking they are not safe…a patient had a cardiac arrest, we discovered that it was because of a delay in suctioning and that the tube had blocked. Had it been that we did the suctioning at the right time. this patient couldn’t have arrested, but because of the understaffing we were busy taking care of the other patient not knowing that the tube on the next patient was blocking. It was bad to us, because our intention is to save lives” (Participant 4, NMT)

“My colleague was very tired and it was during the night, he wanted to prepare 10% dextrose, so he went to take the vails but he didn’t read on the vials. So instead of taking 50% dextrose he took lignocaine, I asked him “what are you doing?” and he said “am preparing 10% dextrose” then I said “look this is lignocaine”, he said “oh I didn’t notice that this is lignocaine” so he had to discard that and start all over again, later he said “what if you were not around, that means I could have killed the patient” but he said “it’s because am tired” (Participant 4, NMT)

Impact on nurse capacity

Perceptions indicated that high nursing workload affects nurses’ capacity to perform negatively

“We are always exhausted and the care which we give to the patient, I can confirm that it can’t be 100% correct” (Participant 9, NMT)

“Performance is poor. The performance is poor, not because am poor as such, but it’s difficult because there is one hand where there should be 2 hands” (Participant 2, NMT)

Impact on nurses’ wellbeing

High nursing workload has both physical and psychological effects

Physical impact—ICU patients attract a lot of nurses’ attention

Psychological impact -Nurses perceived high nursing workload usually brings an increase in psychological issues; stress feelings of guilt, anger and discouragement

“High workload is not good. you have body pains, the legs are aching and you still have to run to help this one and help that one” (Participant 2, NMT)

“It’s very stressful. Its stressful and also you tend to miss some other things like you give medication and you do not document because you were busy with something else” (Participant 1, NMT)

At the end of the day, you become so emotional and you blame yourself sometimes you feel like being a nurse is a not good thing, because when you have a lot of work and when patients get negative outcomes, you feel bad about it so it affects us, it affects me negatively” (Participant 7, NMT)