Title: Exploring nurses experience with benzathine penicillin administration for patients with rheumatic heart disease in Tikur Anbessa Specialized Hospital: A qualitative study using the COM B model
Abstract:
Background: Nurses have a unique opportunity to lower rheumatic fever recurrences through the administration of Benzathine Penicillin G (BPG) a widely used secondary prophylaxis. However, fear of side effects, absence of medication administration skills, trust and communication among nurses has had a negative impact on BPG administration. Overall, the administration of BPG remains low. Therefore, this study aimed to explore nurses’ experience [of BPG administration in Tikur Anbessa Specialized Hospital.
Methods: This qualitative research was guided by the COM-B (capability, opportunity, motivation)-Behavior model and the BCW (Behavior change Wheel). In-depth interviews were conducted among cardiac and generic practice nurses with BPG administration experiences from adult and pediatric cardiac service areas. Thematic analysis was carried out using Braun and Clark’s approach.
Results: Capability barriers commonly discussed were limited skills in safe BPG injection and misunderstanding of BPG prophylaxis. Lack of reference guidelines, unavailability of BPG and other medications, limited healthcare resources (staff, supplies, injection room) and limited inter-professional communication were identified as opportunity barriers. Demotivators of BPG administration were limited intention to provide BPG due to fear of anaphylaxis, legal accountability and lack of injection administration confidence. However, working experience with RHD patients, knowledge of RHD, availability of needed resources, support from nurse colleagues, absence of side effects during previous injections and professional responsibility were identified as enablers of BPG administration.
Conclusions: Both barriers and facilitators related to the BPG administration experience of nurses were identified. Mapping of identified barriers onto COM-B and the BCW were used to identify potential future interventions. Training, education, environmental restructuring and enablement of what were commonly identified interventions to enhance nurses’ BPG administration.
