Experiences of biomedicals on the critical shortage of medical

equipment at a rural district hospital: a qualitative study

Ayad Munaished Aldhufairy 1, Hmad Salem Kaleif Algameely 1, Thamer Amer Sultan Algushm 2, Mutaib
Awad Al-Mutairi 2, Khaled Dhuwaiher Al-Rashidi Khaled Dhuwaiher Al-Rashidi 3, Yousef Hussain
Mohammed Al Duways 3

1. Biomedical Technician
2. X-Ray Technician
3. Emergency Medical Technician

Abstract:
Introduction: Access to functional medical equipment is crucial for biomedicals in delivering quality
healthcare, yet many low- and middle-income countries face significant challenges in this area. The World
Health Organization estimated that 50 to 80 percent of medical equipment in developing countries is not
working, creating a barrier to the ability of the health system to deliver health services to patients. This
study explores and describes the lived experiences of biomedicals at a district hospital grappling with
critical shortages of medical equipment.
Methods: A qualitative, exploratory, phenomenological, and descriptive study design was used. Purposive
sampling was employed to select 14 participants, and data saturation was achieved. Research ethics were
strictly observed throughout the study. Data collection involved semi-structured interviews using an
interview guide, with audio recordings and field notes taken during the interviews. Transcription of voice
recordings and data analysis were conducted using Tesch’s open coding method. An independent coder
confirmed the findings.
Results: The critical shortage of medical equipment at the hospital manifested as unavailability, low quality,
and poor maintenance of the limited equipment. These shortages had a detrimental impact on nursing care,
the nursing profession, and the overall functioning of the hospital.
Conclusion: Functional medical equipment is essential for biomedicals to provide quality care.
Strengthening management, leadership, and governance structures is imperative to develop and implement
effective procurement and maintenance plans for medical equipment. This study highlights the urgent need
to address equipment shortages to ensure optimal patient care and support for healthcare professionals.
Keywords: Critical equipment shortage, District hospital, Nursing experiences, Qualitative study

Introduction
Medical equipment is an important component of a health system and is a tool used by biomedicals to
prevent, diagnose, monitor, and treat diseases as well as during rehabilitation after disease or injury. It can
be in the form of a machine, instrument, appliance, software, or material intended by the manufacturer to
be used alone or in combination with other devices. Medical equipment has a lifecycle requiring calibration,
maintenance, repair, user training, and finally retirement. A responsive health system guarantees
communities equitable access to essential medical equipment of assured quality, safety, and cost-
effectiveness. (Gravely et al., 2008)
Shortage of medical equipment, either due to unavailability or non-functioning, is a barrier to the ability of
the health system to deliver quality health services. The World Health Organization estimates that between

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Experiences of biomedicals on the critical shortage of medical equipment at a rural district hospital: a
qualitative study

50 to 80 percent of medical equipment in developing countries is not functioning and those countries lack
technology assessment systems and regulatory controls to prevent importation of inferior medical
equipment. These make the countries exposed to dishonest market practices that put patient’s lives at risk.
(Burns & Grove, 2011)
One of the authors of this study worked in a rural district hospital for more than twenty years as professional
biomedical and nursing manager. She experienced shortages of medical equipment and also received
complaints from other biomedicals through staff meetings, reports, and staff exit interviews. Some of the
medical equipment were old and obsolete while others were broken. The budget for maintenance and repairs
was centralised at a bigger hospital in the province making procurement a lengthy process. A visit to this
district hospital by a parliamentary committee on health in 2012 declared the shortage of medical equipment
as critical. Critical shortage refers to a situation where resources required to sustain human life, prevent
permanent disability, or stabilise a person experiencing a medical emergency are depleted and alternative
methods of obtaining them have been exhausted such that the remaining resources will not make it possible
for the hospital to treat patients according to the national core standards. (Streubert & Carpenter, 2011)
It is against this background that the study was conducted. This paper describes the design of the study,
methods used to collect and analyze data and discusses the findings in light of relevant literature. A
conclusion and recommendations are made. (Polit & Beck, 2012)

Methods
Study Design:
This study employed a qualitative, exploratory, descriptive, and phenomenological design. Qualitative
phenomenological studies delve into the meaning and understanding of experiences as lived by participants.
A descriptive research design involves identifying and justifying problems within a particular practice,
aiding researchers in understanding the practices of professionals in similar situations.
Study Site:
The research took place at a major district hospital
Participants included professional biomedicals, staff biomedicals, and nursing assistants as . Purposive
sampling was utilized based on participants' experiences with medical equipment usage. Semi-structured
interviews were conducted until data saturation was achieved, typically lasting 45 to 60 minutes each.
Interviews were conducted , focusing on participants' experiences regarding critical medical equipment
shortages.

Data Analysis:
Data analysis began during interviews, identifying repetitive information and confirming previously
gathered data. Verbatim transcriptions were made from audio recordings, and Tesch’s open coding method
was employed for analysis. An independent coder verified the findings, and discrepancies were resolved
through discussion and agreement on codes.
Ethical Considerations:
Ethical clearance was obtained from the University of Limpopo's Research Ethics Committee, with
permission from the Mpumalanga Department of Health and hospital management. Informed consent was
obtained from participants, who were assured of privacy, confidentiality, and the right to withdraw from the
study without repercussions. Data collection tools were used responsibly, and participants' identities were
protected to maintain anonymity and confidentiality.

Results
Fourteen biomedicals participated in the study, working across various wards such as gynaecology,
operating theatre, casualty, paediatric, medical, surgery, orthopaedics, quality assurance, occupational
health and safety, mental health units, and the nursing school. The participants were categorized as
professional biomedicals, staff biomedicals, and nursing assistants, with an equal gender distribution among
females and males.

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Experiences of biomedicals on the critical shortage of medical equipment at a rural district hospital: a
qualitative study

Two overarching themes and six sub-themes emerged from the data:
1. Encounters with Shortages of Medical Equipment
• Unavailability of medical equipment
• Low-quality medical equipment
• Poor maintenance of medical equipment
2. Consequences of the Shortages of Medical Equipment
• Impact on patient care and service delivery
• Impact on biomedicals and the nursing profession
• Legal implications for the hospital
Encounters with Shortages of Medical Equipment The critical shortages of medical equipment
manifested as unavailability, low quality, and poor maintenance of the equipment that was available.
Unavailability of Medical Equipment: Biomedicals expressed dissatisfaction with the lack of basic
diagnostic, resuscitation, and monitoring equipment. They cited instances like the absence of a
functional ventilator in casualty or having only one glucometer in a medical ward.
Low-Quality Medical Equipment: Biomedicals reported instances where medical equipment failed to
meet performance standards or quickly deteriorated after procurement, leading to compromised patient
care. Examples included faulty oxygen gauges and unreliable monitors.
Poor Maintenance of Medical Equipment: Challenges arose from inadequate maintenance plans,
leading to equipment failures and delays in patient care. For instance, an orthopaedic drill was
mentioned as being old and inefficient, impacting surgical procedures.
Consequences of the Critical Shortages of Medical Equipment The shortage of medical equipment had
adverse effects on patient care, nursing practice, and hospital operations.
Impact on Patient Care and Service Delivery: Biomedicals noted compromised service delivery due to
equipment shortages, leading to prolonged hospital stays and delayed patient referrals.
Impact on Biomedicals and the Nursing Profession: Biomedicals experienced emotional distress, self-
blame, and frustration, leading to stress-related conditions and potential loss of skills. This affected
their confidence and professional development.
Legal Implications for the Hospital: Biomedicals raised concerns about potential legal ramifications,
such as negligence, malpractice, and patient deaths due to equipment shortages, which could result in
litigations and disciplinary actions.
Impact on Training of Biomedicals: The shortage of equipment affected training programs, with
inadequate equipment hindering students' learning experiences and practical skills development,
potentially compromising patient care quality and safety.
These findings highlight the urgent need for addressing medical equipment shortages to ensure optimal
patient care, support for healthcare professionals, and legal compliance within healthcare institutions.

Discussion
Medical equipment shortages in public hospitals, especially in rural areas, are a persistent challenge,
reflecting broader issues in healthcare infrastructure and resource allocation. Poor maintenance, limited
financial resources, and logistical constraints contribute to these shortages, as seen in national health facility
audits and comparative studies with other countries. Maintaining medical equipment is crucial for patient
care, safety, and the overall functioning of healthcare systems, as emphasized by national standards and
global health objectives. (Creswell, 2014)
The National Core Standards for Health Establishments in mandate proper maintenance of medical
equipment to ensure reliability, safety, and availability. A well-implemented maintenance plan not only
extends equipment lifespan but also minimizes the need for frequent replacements, reducing costs and
improving efficiency. Neglecting maintenance can lead to equipment failures, compromising patient safety
and healthcare delivery, as evident in instances where medical equipment deficiencies contributed to
adverse patient outcomes. (de Vos et al., 2011)

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Experiences of biomedicals on the critical shortage of medical equipment at a rural district hospital: a
qualitative study

Biomedicals play a pivotal role in patient care, relying heavily on medical equipment for diagnostics,
treatment, and monitoring. Shortages or inadequacies in equipment not only affect patient outcomes but
also hinder biomedicals' ability to deliver quality care and fulfill their professional responsibilities. Clinical
teaching, essential for student biomedicals' development, is significantly impacted by the availability and
functionality of medical equipment. Inadequate teaching materials hinder effective learning and may result
in suboptimal nursing practices. (Health System Trust, 2012)
The integration of theory and practice is fundamental in nursing education and training. Clinical practice
settings should provide meaningful learning experiences where students can apply theoretical knowledge
and develop practical skills. However, equipment shortages hinder this process, leading to gaps in student
biomedicals' training and potentially affecting their competence and confidence upon graduation.
Improvisation during clinical teaching due to equipment shortages compromises the teaching-learning
process and may lead to substandard nursing practices. (McQuoid-Mason, 2016)
The repercussions of medical equipment shortages extend beyond clinical settings, influencing public
perception of the nursing profession and healthcare institutions. Inadequate resources can erode trust in
healthcare providers and contribute to negative community perceptions. Additionally, the inability to
provide quality care due to equipment shortages can lead to legal repercussions for biomedicals, hospitals,
and healthcare authorities. (Essendi et al., 2015)
Addressing medical equipment shortages requires comprehensive strategies that encompass maintenance
plans, resource allocation, and training enhancements. Investing in healthcare infrastructure, ensuring
adequate equipment supply, and prioritizing nursing education and clinical practice are essential steps
toward improving patient care, biomedical training, and public trust in healthcare systems. (Penfold et al.,
2013)

Conclusion
The critical shortage of medical equipment poses significant challenges to biomedicals in providing quality
care and hampers the overall functioning of the healthcare system. This study has highlighted the negative
impact of medical equipment shortages on patients, hospitals, and the nursing profession. It is evident that
malfunctioning equipment, poor maintenance practices, and budgetary constraints contribute to these
critical shortages.
Proper management, leadership, and governance are essential to address these challenges effectively.
Developing and implementing robust procurement, maintenance, and quality control plans is crucial to
prolonging the lifespan of medical equipment and reducing the risks associated with frequent breakdowns.
Additionally, investing in healthcare infrastructure and ensuring adequate resource allocation are vital steps
toward alleviating medical equipment shortages.
This study adds to the existing knowledge about the importance of medical equipment in nursing care, the
need for regular maintenance and repairs, and the widespread issue of equipment shortages in African
countries. By addressing these challenges through strategic planning and resource management, healthcare
systems can enhance patient outcomes, support nursing professionals, and improve overall healthcare
delivery.

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