Purpose: Evaluate nurses' and caretakers' perspectives of quality care, barriers to its delivery, and its study in a
humanitarian setting.
Methods: A qualitative study using semi-structured interviews and direct observation was conducted in the pediatric
department of Magburaka Hospital, Tonkolili district, Sierra Leone. Interviews were recorded, transcribed, and
inductive coding was used to identify prevalent themes. The observation was used to compare and elaborate on
interview findings.
Results: Three themes emerged holistic care; the nursing community; and organization and systems of care. For
caretakers, holistic care related to their child’s survival, with quality care described as the availability of free
medication, provision for basic needs (food, water, shelter, sanitation), hospital cleanliness, and psychosocial
support. For nurses, this involved medication administration, cleanliness, and carrying out nursing tasks (e.g., taking
vital signs). Observation revealed caretakers, without nursing involvement, performed the majority of “activities of
daily living” (e.g., bathing, toileting). The nursing community describes nursing employment types, attitudes, and
how a lack of teamwork impacted quality nursing care. The third theme outlines the importance of organization and
systems of care, in which training and a good salary were perceived as prerequisites for quality nursing care, whilst a
lack of resources and inadequate operational systems were barriers.
Conclusion: Caretakers play an integral role in the delivery of quality care. This and important quality care
components outlined by nurses and caretakers identified a patient and family-centered approach could contribute to
improving quality nursing care in humanitarian settings.