Barriers to adherence to endotracheal tube suctioning guidelines among intensive care nurses at a Tanzanian national hospital: A qualitative study

Abstract

BACKGROUND: Endotracheal tube suctioning (ETS) is a critical procedure for mechanically ventilated patients. Evidence-based guidelines exist to ensure its safe performance; however, adherence remains suboptimal, especially in resource-limited settings. This study aimed to explore the barriers to ETS guideline adherence among ICU nurses at Muhimbili National Hospital (MNH), Tanzania. METHODS: An exploratory qualitative study was conducted in the medical and surgical ICUs of MNH. Seventeen ICU nurses with ≥1 year of experience were purposively sampled. Semi-structured interviews were performed, audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis following Braun and Clarke's framework. RESULTS: Three key barriers emerged: (1) Resource scarcity, including critical shortages of staff, equipment, and supplies; (2) Human and behavioral challenges, such as knowledge deficits and resistance to change away from routine practice; and (3) Guideline accessibility and usability, concerning poor accessibility and a perception that guidelines were not tailored to the local context. CONCLUSION: Non-adherence to ETS guidelines primarily reflects systemic constraints rather than individual neglect. Strengthening adherence requires multi-level interventions: improving staffing and resources, providing continuous training, and adapting international guidelines to the local context.