Exploring nurses’ experience with benzathine penicillin administration for patients with rheumatic heart disease in Ethiopia: a qualitative study

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, lack of administration skills, and communication among nurses has had a negative impact on BPG administration in Africa. Overall, the administration of BPG remains low. Therefore, this study aims to understand the experience of nurses with BPG administration in Tikur Anbessa Specialized Hospital to inform an intervention to improve BPG administration rates in Ethiopia. Methods This qualitative research was guided by capability, opportunity, motivation-Behavior model (COM-B) and the Behavior change Wheel (BCW). 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 The study included 26 both general and cardiac nurses. 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 had 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 Barriers of BPG administration such as poor nurses’ intention due to fear of adverse effects, medico-legal concern, and absence of consent and injection room were mapped 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. Multicenter studies are recommended to better understand the factors and address barriers. A study is recommended to test effectiveness of interventions recommended based on the research findings. Clinical trial number Not applicable.