ORGANIZATIONAL AND INDIVIDUAL FACTORS LEADING TO CLINICAL PRACTICE DEVIATIONS AMONG NURSES IN PAKISTAN: A QUALITATIVE STUDY

Abstract

Background: Clinical practice deviations among nurses can compromise patient safety, yet little is known about the interplay of organizational and individual factors contributing to these deviations in Pakistan. Objective: This study aimed to explore the systemic, educational, and behavioral factors influencing clinical practice deviations among nurses in public and private healthcare settings in Pakistan.

Methods: A qualitative case study design was employed. Twelve participants, including six clinical nurses and six administrative nurses, were purposive sampled from multiple healthcare facilities. Data were collected through semi-structured interviews and analyzed using Braun and Clarke’s six-phase thematic analysis framework.

Results: Four major themes emerged: (1) Organizational pressures and resource constraints—staff shortages, limited supplies, and unclear policies; (2) Knowledge gaps and skill limitations—unequal training backgrounds and lack of continuous professional development; (3) Individual pressures and behavioral factors—burnout, moral distress, and normalization of shortcuts; and (4) Leadership and supervisory dynamics—inconsistent supervision, communication gaps, and punitive culture. Deviations were influenced by both systemic barriers and personal coping strategies, with clinical nurses emphasizing practical challenges and administrators highlighting policy and cultural issues.

Conclusion: Clinical practice deviations in Pakistani healthcare settings result from a complex interaction between organizational flaws and individual factors. Interventions addressing staffing, resource allocation, training, and supportive leadership are critical to enhancing adherence to clinical standards and improving patient safety.