Experiences of physiotherapists involved in front-line management of patients with COVID-19 in Nigeria: a qualitative study

Abstract

ObjectivesEvidence-based guidelines recommend physiotherapy for respiratory treatment and physical rehabilitation of patients with COVID-19. It is unclear to what extent physiotherapy services are used in the front-line management of COVID-19 in Nigeria. This study aimed to explore the experiences of front-line physiotherapists managing patients with COVID-19 in Nigeria.DesignQualitative interview-based study.SettingICU and hospital COVID-19 wards, COVID-isolation and treatment centres in Nigeria, between August 2020 and January 2021.ParticipantsEight out of 20 physiotherapists managing patients with COVID-19 in the front line were recruited using purposive and snowball sampling.MethodsQualitative in-depth semistructured telephone interviews of all consenting physiotherapists managing patients with COVID-19 in the front line in Nigeria were conducted and transcribed verbatim. Transcripts were thematically analysed.ResultsEight front-line physiotherapists (three neurological physiotherapists, two orthopaedic physiotherapists, one cardiopulmonary physiotherapist, one sports physiotherapist and one rotational physiotherapist) provided consent and data for this study. Four themes and 13 subthemes were generated illustrating discriminatory experiences of front-line physiotherapists, particularly from COVID-19 team leads; lack of multidisciplinary teamwork within COVID-19 teams; wide ranging stigmatisation from extended family members, colleagues, friends and the general public; material and psychosocial personal losses; lack of system support and suboptimal utilisation of physiotherapy in the management of COVID-19 in Nigeria. Personal agency, sense of professionalism, previous experience managing highly infectious diseases and being a cardiopulmonary physiotherapist were the factors that made the front-line physiotherapists to become involved in managing patients with COVID-19. However, discriminatory experiences made some of these physiotherapists to stop being involved in the management of patients with COVID-19 in the front line. Most front-line physiotherapists were not cardiopulmonary physiotherapists which may have influenced their level of expertise, multidisciplinary involvement and patient outcomes.ConclusionsThere is suboptimal involvement and support for physiotherapists, particularly cardiopulmonary physiotherapists treating patients with COVID-19 in the front line in Nigeria.

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“…The learning outcomes enable them to assess the communication needs of the patient/community. As India has made AETCOM compulsory in the first year, core skills in communication (listening, interpreting, body language, writing, reading, and reasoning) are inculcated, and the learner can communicate effectively with patients, the community, and colleagues in a respectful nonthreatening, nonjudgmental, and empathetic manner [ 33 ].…”

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“…The numbers of persons in Europe who identify themselves as non-religious are higher than in the rest of the world; in some European countries it is up to 70% of the population [89]. Spiritual beliefs of physiotherapists in Nigeria for example, were reported as drivers of physiotherapists' personal agency when providing frontline services in the early SARS-Cov-2 pandemic, whilst experiencing discrimination and stigma on several levels [90]. Participants from the AR disagreed with the statement that emotions play a role in their ethical decisionmaking; but it was rated as neutral by participants from the ER and the SAR.…”

Perceptions of and Reactions to the HR Implementation Process in Nigeria

“…In the banking sector, however, line managers' role in the HR implementation is limited to on-the-job training, employee relation, performance appraisal, and individualised pay awards while the HR department is responsible for administrative functions such as recruitment, payroll, and external training [41]. HR departments also provide clear direction and adequate training the line managers to execute their 'newly' devolved HR practices, as a lack of HR-related competencies and skills is likely the affect their effectiveness in the HR implementation process [42].…”

“…However, the high level of unemployment in Nigeria and the pressure to meet competing business (e.g. quality and productivity) demands alongside HR activities may affect the way line managers implement HR practices [42] For example, line managers may enact HR practices with a focus on short-term goals over the long-term strategic vision of their organisation. They also may behave inconsistently and thus, deviates from the strategic goals of their organisation.…”

“…They also may behave inconsistently and thus, deviates from the strategic goals of their organisation. Under this circumstance, scholars have suggested HR department HR specialists/HR departments and line managers should form a partnership in developing and managing HR practices to achieve a unitarist approach to people management [42].…”