Nurses' experiences in adhering to infection prevention and control guidelines during the COVID-19 pandemic: a qualitative comparative study between Nepal and Scotland.

BACKGROUND

The COVID-19 pandemic exposed major gaps in infection prevention and control (IPC) worldwide. Despite guidance from organisations such as the World Health Organization (WHO), nurses, as frontline responders, faced considerable challenges in implementing IPC practices globally. This study compared nurses' experiences in Nepal and Scotland in adhering to IPC guidelines during the COVID-19 pandemic using a theory-based approach.

METHODS

A generic qualitative research design with a cross-national comparative approach was employed. The Capability, Opportunity, Motivation-Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) guided the study. Online interviews were conducted with 22 registered nurses (12 from Nepal, 10 from Scotland) working in acute care settings during the pandemic, in their native languages. Data were analysed using Reflexive Thematic Analysis and managed with NVivo 20 software.

RESULTS

In Nepal, factors related to 11 of the 14 TDF domains influenced adherence, while in Scotland, 10 domains were relevant. All components of the COM-B model, Capability, Opportunity, and Motivation, were identified as influencing adherence to IPC guidelines in both countries. Nurses in both countries experienced similar barriers to adherence, including challenges in adapting to changing guidance, gaps in knowledge, skills and training, psychosocial stressors, and organisational changes. Differences were noted in infrastructure and leadership styles.

CONCLUSIONS

This study provides a theory-informed understanding of how behavioural, organisational, and environmental factors influenced nurses' capability, opportunity, and motivation to adhere to IPC guidelines. These insights provide a foundation for developing targeted interventions to improve adherence and strengthen preparedness for future infectious disease outbreaks.