Cross-cultural perceptions of infection prevention and control climate among Lebanese and Norwegian nursing students’ post COVID-19: a qualitative descriptive study

Abstract

Background

The aim of this research was to explore Lebanese and Norwegian nursing students’ cross-cultural perceptions of infection prevention and control (IPC) climate of their training hospitals after COVID-19.

Design

A qualitative descriptive research design informed by descriptive phenomenology was used.

Method

Semi-structured interviews were conducted among 8 Lebanese and 7 Norwegian nursing students. Data collection continued until data saturation was achieved. Inductive thematic analysis was employed over the course of 3 months.

Results

The thematic analysis yielded four themes reflecting professional and behavioral influences on IPC, including “Positive perception and importance of IPC”, “Lacking a Role Model”, and “Prioritizing task completion over safety”, and “Feeling Incompetent”. Cross cultural differences were mainly connected to organizational and contextual factors, namely: “Lack of equipment”, “Culture of patient contact”, “Heightened attention vs. variable adherence to IPC”, and “Organizational differences”.

Conclusion

Lebanese and Norwegian nursing students shared highly similar experiences and challenges in infection prevention and control, while some culturally relevant differences were noted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-026-04855-x.

Introduction

With over 621 million cases reported and over 6.5 million fatalities, the COVID-19 pandemic has been the worst global outbreak in more than a century [1]. Because of the scarcity of protective gear and the uniqueness of the virus’s rapid mode of transmission, nurses and other healthcare professional struggled to assume their professionals roles, and realized that their health and safety is compromised. Consequently, nurse practitioners and healthcare workers have reported unprecedented rates of personal and professional exhaustion and burnout, worldwide, due to the persistent COVID-19 pandemic [2]. Nurses and healthcare workers were committed to safety measures that included vaccination, distancing, wearing masks, and limiting social interaction; nevertheless, such fundamental protective measures were not sufficient to ensure adequate protection of nurses from being infected with high rates [3]. The likelihood of severe health catastrophes like COVID-19 is increasing unfortunately. Research indicates that the likelihood of global disease outbreaks with effects comparable to COVID-19 was around 2% in any given year and increasing, due to variables such as population expansion, modifications to dietary habits, and ecological deterioration [4].

Healthcare institutions proceed to struggle in providing high-quality services in the face of the growing incidence of healthcare-associated infections (HCAIs). Because these infectious diseases have a large and negative influence on the standard of patient care, HCAIs are considered as one of the most serious healthcare issues [5]. Evidence-based bundles have been shown to be successful in reducing infection levels despite variations in application and adherence across healthcare institutions [6]. As a result, hospitals need to integrate infection prevention into their corporate culture. Standard precautions (SPs) adherence among staff and maintaining a high-quality infection control environment in healthcare institutions are challenging tasks [7, 8].

The effort to eradicate HCAIs internationally has given rise to the concept of the infection prevention and control (IPC) climate in healthcare institutions. The perceived importance of safety at a given organization at a given time is known as the safety climate [9]. As a result, the perspective that Healthcare Workers (HCWs) have in common about infection prevention at their institution may be used to describe the IPC climate. The safety climate comprises a number of components, including teamwork, leadership, communication, workload, and safety systems [10]. Unlike safety climates, IPC climates specifically focus on infection-related practices, standard precautions, and prevention of HAIs. According to a prior systematic review, the working environment of HCWs has a significant impact on their adherence with infection prevention measures such as handwashing recommendations [11].

Due to their frequent proximity to patient populations in the clinical setting throughout their practicums, nursing students are subject to a variety of hazards. Because of their close contact with patients and healthcare workers, nursing students may potentially add to burden of cross-infections in hospitals if infection prevention and control (IPC) guidelines are not adhered to [12, 13]. Hence, guaranteeing that nursing students adhere to SPs, as much as possible, is substantial. By examining students’ how the infection prevention culture influences student adherence, strategies may be devised and put into place at the institutional level. This would enhance nursing students’ adherence to SPs and IPC procedures, which will contribute to lessen the hospital acquired infections. Nonetheless, a substantial body of research suggests that nursing students are routinely pressured to practice standard precautions due to their perspectives of the IPC climate of their practice settings. This is regardless of their comprehension of HAIs and their practical experience with disease prevention and patient safety [10]. Yet, there is a need to enhance our understanding and the body of the literature with comprehensive data connecting student nurses’ perceptions of IPC climate to standard precautions adherence.

Throughout the past 20 years, investigations have shown that varying hospitals have distinct approaches to infection prevention, such as the application of standard precautions in various healthcare contexts and care situations [14, 15]. These discrepancies might be related to various healthcare environments’ IPC climates. In a previous exploratory research, the variations in infection prevention climate - hereafter referred to IPC climate to represent both control and prevention practices - were attributed to standard precautions, technical processes, nursing shortage, infection monitoring, and standard precautions adherence evaluation [16, 17].

The globalization of nursing, increasing regularity of international events, and variation in healthcare systems incentivize the investigation of the universal experiences of nurses and students across cultural contexts [18]. The scope of the current study is essential for recognizing the overarching trends that cut across cultural boundaries and can highlight institutional, regional, and national measures that may help nurses and nurse leaders comprehend, prepare for, and encourage the international nursing workforce to reach a better IPC climate. As the biggest healthcare profession, nursing is frequently on the front lines of early infection outbreak management and pandemic monitoring. Thus, comparing nursing practices across cultures would be the first step to picking up on the international trends. We were unable to find any study that examined the perspectives of nursing students across cultures, despite the abundance of existing research investigating student nurses’ perspectives during COVID-19.

Norway and Lebanon were selected for this cross-cultural comparative research because their governments responded in quite different ways to COVID-19 which tells a lot about the culture of infection prevention and the level of seriousness it is dealt with [19]. On February 26, 2020, Norway reported its first incidence of COVID-19. Nevertheless, the fast public health reaction by the Norwegian authorities reduced the amount of infections [19]. While the first case in Lebanon was detected on February 21, 2020, a public health emergency was not declared there until March 15, 2020. The floundering administration, the economic crisis, the security situation, and political unrest were among the factors that contributed to the public health response in Lebanon being more disjointed and protracted than it was in Norway [20]. This contrast offers an opportunity to study how different organizational practices, healthcare structures, and clinical announcements influence nursing student’s perspective of IPC climate. Additionally, the accessibility of Norwegian students through an exchange program enabled for the examination of perspectives that are rarely attainable. Consequently, the purpose of this research was to explore nursing students’ perceptions of IPC climate through qualitatively comparing and contrasting their clinical experiences after COVID-19 in two distinct cultural and clinical environments, namely Lebanon and Norway.

Methods

Research design

The research approach used in the study was qualitative descriptive, guided by Husserlian descriptive phenomenology, which uses simple language to explain a phenomenon [21]. This approach aims to capture the description of experiences accurately, documenting the who, what, and where of experiences or occurrences, without interpreting underlying motives [21, 22]. The design used was informed by Husserlian descriptive phenomenology considering that the research at hand is tackling description of experiences [23]. In accordance with this framework, the study recognizes that the participants’ experiences are influenced by social factors with the context [24]. The COREQ guidelines were followed in developing this manuscript.

Setting and sampling

The study was carried out at one major private university in Lebanon which offers an accredited 3-year bachelor nursing program and is affiliated with multiple university hospitals in Lebanon. The university is actively engaged in student exchange programs through ERASMUS+, where it receives and sends students for both theoretical learning and clinical training for periods ranging from 3 to 6 months. The exchange program allowed for the Norwegians to be exposed to a culturally different environment, enabling the exploration of cross-cultural perceptions. In this study, this is relevant to Lebanon and Norway’s clinical setting difference in resource availability and organizational practices, especially their responses to the COVID-19 pandemic, which may affect IPC climate [19, 20]. A purposive sampling design was adopted to recruit senior nursing students both from Lebanon and Norway. Recruitment continued until saturation was reached at 8 students from Lebanon and 7 students from Norway. For the Lebanese students to be eligible to participate, they had to be senior students, actively registered in the bachelor nursing program at the approached higher education institution, completed their required clinical hours, were not enrolled in another program as a double major, did not graduate from any other undergraduate or post-graduate major, did not receive a technical degree in nursing, were not enrolled in the nursing bridging program (technical to bachelor acceleration), and are well versed in English. As for the Norwegian students, they were recruited from the most recent incoming cohort from a well-known university in Norway, which also provides a very similar nursing bachelor program. For them to be eligible to participate, they had to fulfill the same inclusion criteria in addition to having fulfilled the clinical requirements at their sending institution, and completed the whole exchange mission and fulfilled the required clinical hours at the receiving institution.

Recruitment and data collection

Considering that the students were regularly in contact with the primary researcher, as being the director of the exchange program, the students were approached by a trained research assistant. The research assistant approached the students in between classes and invited them to participate in the study. Thus, any possible power differential would not have caused a coercion factor that influenced the students to provide consent. The research assistant provided the students with an information sheet and explained the aim of the study. Those who were willing to participate signed a written informed consent and scheduled a one-on-one interview, at a time and place convenient to them. Data was collected until saturation was reached at 8 students from Lebanon and 7 students from Norway. Saturation was determined when no new information emerged from interviews. Information regarding non-participation (dropout or refusal) was not reported. Data collection extended between January 2023 and March 2023.

Interviews

Semi-structured interviews were conducted by a female research assistant (Ph.D. student in nursing) who did not have any prior contact with the students, and had no contact with the clinical instructors or clinical settings in which they have conducted their training. The interviewer is trained in qualitative interviewing and research. The interviewer informed participants that the study was being conducted for publication and academic purposes. The interviews were conducted in the naturalistic setting at convenient times. The interviewer bracketed any previous knowledge on the topic, practiced reflexivity during the interviews to minimize preconceptions and dressed appropriately to not intimidate the students. The respondents were alone with the participants, no non-participants, to talk freely about their experiences and perceptions, and each interview lasted between 45 min and one hour. The interviewer introduced himself and reintroduced the objective of the interview. He re-confirmed permission to audiotape the interviews and reassured the participants that all interactions will be anonymous and confidential. No repeat interview occurred. During the interviews, field notes were taken to reflect on any non-verbal cues and contextual information that might be pertinent to the analysis. Krueger and Casey [25] interview guide was adopted, where introductory, transition, and then key questions were used. Probing questions and final prompt questions were used as appropriate. The two groups of students were asked the same questions, however, the Norwegian students were asked extra questions to explore cross-cultural nuances of IPC climate (Table 1, Supplementary File 1).

Table 1.

Interview questions

Introduction Question	What are your thoughts on the phrase “infection prevention and control climate”?
Transition Question	What were your impressions of the infection control climate at your clinical training settings?
Key Questions	What challenges did you face to apply IPC measures?
	What changed from before, during and after the COVID pandemic?
	Is there anything that might be done to enhance infection prevention and control climate?
	Describe how your culture contributes to infection prevention and control climate.
For Norwegian Students	How did the infection prevention and control climate differ between Lebanon and Norway?
	How did the transition between care contexts and clinical cultures affect your practice?
Final prompt	Do you have anything further to say ?
Probing Questions	Could you give us a better description?
	Could you provide us with a better description?

Data analysis

The research assistant who conducted the interviews listened to the audio tapes repetitively and transcribed the interviews thoroughly. The transcripts were de-identified from explicit and implicit identifiers. The students were given pseudonyms. The transcripts were then handed to the research team for analysis. Colaizzi’s seven steps of descriptive phenomenological method was used, which includes [1] reading and re-reading the transcripts [2], coding significant statements [3], developing meanings [4], developing categories and themes [5], providing thick description [6], identifying structure of phenomenon, and [7] validating the findings with the participants. Colaizzi’s seven steps method was utilized as a systematic approach to extract and organize the themes. This method is in alignment with the Husserlian descriptive phenomenological design that is guiding this study, ensuring that findings arise from participants’ lived experiences. While the first six steps were implemented, the research team was not able to validate the findings with the participants due to logistic constraints. Themes were derived inductively without imposing pre-existing categories. Analyst triangulation was employed in order to challenge the team members’ assumptions and keep the findings grounded in the data. Each team member immersed themselves in the data and coded separately and developed tentative themes. Then, the three team members met, discussed the findings and reconciled any differences. The verbatim was repeated several times to ensure that the researchers had a thorough understanding of the students’ perspectives. After that, each quotation was given a representative word that underscored the real essence of the provided data. These words were then clustered, reorganized, and consolidated into qualitative themes, which were then carefully examined by the researchers to ensure that they accurately captured the experience under study. Data analysis was done manually without the assistance of a qualitative data analysis software.

Trustworthiness and credibility

The five-step trustworthiness criteria that is credibility, dependability, confirmability, transferability, and authenticity were used to ensure the rigor of the results [26]. The credibility of the findings was enhanced by using several coders throughout the data analysis stage. This puts the researchers’ assumptions to the test and ensures that the findings are supported by the participants’ testimonies. By establishing an audit trail, the study promoted dependability and confirmability. The audit trail included audiotapes, verbatim transcripts, and field notes, which documented observations, impressions, comments, workflow notes, and the underlying assumptions of analytical judgments. Transferability was enhanced by detailed descriptions of the participants’ narratives and the presenting the characteristics of the targeted sample. These in-depth depictions and the inclusion of respondent quotes in the findings aided in fairly and accurately reflecting the range of personal viewpoints.

Ethical considerations

Beirut Arab University, where the data was gathered, provided the Institutional Review Board approval (IRB number: ECO-R-130). After being assured that participating in the research is entirely voluntary and that dropping out has no adverse effects, each respondent voluntarily provided written informed permission. Also, it was emphasized to the students several times that their involvement would be anonymous and that any information that was published would not contain any personal information. Each respondent was assigned a pseudonym, and the transcripts were encrypted and anonymized to preserve anonymity. The study team was the only group with accessibility to the transcriptions and recordings; they were kept in a password-protected folder.

Results

Characteristics of the respondents

The sample of the study comprised 15 students in total, eight were from Lebanon and seven were from Norway. The Lebanese sample comprised four males (50.0%) and four females (50.0%), while the Norwegian sample consisted of four females (57.1%) and three males (42.9%). The average age in the Lebanese sample was 21.4 years while it was 22.3 years in the Norwegian sample.

Qualitative findings

Similarities

The thematic data analysis resulted in four themes under the similarities in perceiving the IPC climate among Lebanese and Norwegian students namely, “Positive perception and importance of IPC”, “Lacking a Role Model”, “Prioritizing task completion over safety”, and “Feeling Incompetent”. The results show that the nursing students share universal experiences and perceptions regarding clinical training and concepts relating to infection prevention despite the variable clinical environments, curricula, and learning contexts.

Positive perception and importance of IPC

The students who took part in the study whether Lebanese or Norwegian emphasized the importance of infection prevention and control measures to be strictly adhered to as it relates to issues of patient safety. They reported that they understood the basis of control protocols which enabled them to properly practice standard precautions. The students also indicated their important role as nursing students to be contributing to the culture of safety and infection prevention. For instance, one of the students said, “…umm of course, I think it is extremely important to be very alert about instances where you might actually contract an infection or contribute to its propagation…it’s not something to be taken lightly…everyone is responsible even us students…” (S3, N). Another student also emphasized, “…it is not what just one person is doing…it is the whole system…we are all involved…it is a team effort…” (S1, L). Another testimonial was, “…it is a whole machine that is working together to prevent infection…if you do not believe in it does not work…” (S7, N). However, some points in their practice, especially during early years, multiple students felt that they were confused about what to do and about their role in contributing to the infection prevention culture. For instance, one of the students said, “…sometimes I used to get lost about what is the right thing to do especially when I was practicing in closed units like the ICU…it is a bit scary especially being around infected patients…I felt like I maybe l leave it to the professional nurse…she knows better than I do…like how do I safely hand a tracheostomy care for example…” (S4, L). Another student also proclaimed, “…it is scary at the beginning… without proper guidance you would not know if you actually did the right thing or not and on top of that like…how can I contribute positively as a student to propagate this culture of safety when sometimes in the earlier years I felt unsure about certain protocols…like if I did something wrong or I saw something wrong how di report” (S2, N).

Lacking a role model

Both Lebanese and Norwegian students felt that at many points they were struggling not to be influenced by more senior nurses’ practices regarding infection control. The students reflected on how some practicing nurses were not good role models for them, throughout their clinical training experience. This affected their perception of the seriousness with which infection prevention and control was dealt with and handed them slip into errors. For instance, one of the students said, “…I go into my practice doing handwashing properly, donning and doffing my PPE as I should and then I look at the nurses, they are not doing any of that properly… unconsciously I start mimicking that kind of practice because the general attitude was like .meh we do not care so why should you… and I run into trouble with my clinical instructor…” (S5, L). Another student also proclaimed, “…sometimes even when I am assisting a nurse and I am taking of these infection control details…I get side eyes from some of the nurses like look at the beginner…some giggling…because I am taking my time in doing these things or they are just not very interested in what I am doing because they don’t do this…or it’s not important…” (S6, N).

Prioritizing task completion over safety

Another theme that highlighted the challenges which faced both Lebanese and Norwegian students related to high workload and stressful environment that both nurses and student nurses are sometimes subject to which can lead to pitfalls in maintaining the IPC climate. For instance, one of the students said, “…during rush hours, like medication dispensing time or blood drawing or IV checks…it is very hectic you could barely make it on time to cover all your patients…too many patients not enough staff. So, I would be shadowing a nurse and many mistakes happen that they should not…sometimes you really understand why these are happening because it can get absurdly overwhelming…” (S5, L). Another student also emphasized this idea, “…it is so stressful for the nurses and for us students…I mean there is not enough time sometimes to really be diligent…it is crazy…when I am practicing sometimes nurses take the procedure from me to catch up on the workload because I would like to pay attention to the infection control measure or the aseptic technique and they are faster and more efficient…but this affects my skill acquisition and demotivates me…” (S4, L). The students highlighted the importance of staffing and psychological protection of nurses so that they can comply with infection prevention and control. For example, one of the students said, “…along the protocol for infection prevention, there should be formal counseling and work done to make the hospital setting less stressful…more nurses more understanding…” (S5, N).

Feeling incompetent

The final common theme that emerged among both Lebanese and Norwegian students related to the need for more training among both nurses and students and more stringent evaluation and monitoring to keep the infection control climate in check. For example, one of the quotes was, “…I think students should be more strongly trained on infection control measures since day one…do not let them go in there with the least bit of hesitancy…this is very … and I repeat…very important and to provide vigorous training for students before they go to clinical not just on how to control but also how to report…how to communicate these measures is very important…” (S5, N). Another student also proclaimed, “…both nurses and students need workshops and trainings and regular evaluations to keep their information updated and relevant and their practice aligned…maybe at some points nurses more than students…” (S8, L). A further anecdote was, “…there is lack of strict supervision at some points maybe…we could use team based effort drivers to deepen the culture of infection control…” (S2, N).

Differences

Four distinct themes also emerged through thematic analysis pertaining to differences in perceiving the IPC climate between Lebanese and Norwegian students; “Lack of equipment”, “Culture of patient contact”, “Heightened attention vs. variable adherence to IPC”, and “Organizational differences”. These differences mainly pertained to cultural and economic aspects that influenced practice, COVID response, and organizational protocol variability.

Lack of equipment

The first theme that emerged related to the economic situation in Lebanon, which severely affected the access to medication, medical equipment as well as to personal protective equipment in smaller hospitals. The Lebanese students majorly highlighted this issue. The Norwegian students highlighted the problem during their time practicing in Lebanese hospitals, as being an extraordinary situation that severely affects the IPC climate in Lebanon, yet they never had to deal with such a challenge. For instance, one of the students said, “…since the economic crisis we have been barely able to have gowns or gloves even at some points of the day as the management is severely cutting the amount to be used per day…this is risky… it has been like that for the past two years sometimes better sometimes worse…we get by like there is no major hazard all the time but sometimes we have to borrow from other places and stuff like that…however this is not what an infection control climate standard” (S1, L).

Culture of patient contact

Norwegian students highlighted a very interesting cultural difference in nursing practice in Lebanon. They realized that nurses in Lebanon spend more time in the patients’ room and they more frequently contacted the patient and belongings, which they viewed as a higher challenge for the IPC climate. For instance, one of the students said, “…Lebanese nurses had more patient contact than what we were usually used to in Norway…more time in the room, sitting on the bed of the patient, handling patients’ private stuff and medication bags… even the use of therapeutic touch which I think it relates to the culture of Lebanese people… they have this warm attitude towards patients and tend to provide care in such a personal way that maybe would get them more exposed to infection sources…” (S2, N). Another student pinpointed this in another interview, and it was interesting that they even used similar terms which corroborate the observation of this cultural phenomena from their perspective. The student said, “… at some points of the day the nursing station would be empty for a long time and you would find the nurses in patient rooms chatting or helping around…sitting very close to patients… I even saw nurses handling the patients’ cellphones… or medication bag…no gloves or gown…it is very cultural apparently that this intimate relationship might expose them to more infection…but it is very commendable as their relationships with the patients are astounding, yet I think we need to think about infection…” (S6, N).

Heightened attention vs. variable adherence to IPC

This theme captures a contrasting level of attention and adherence to IPC. “Heightened attention” illustrates careful compliance to protocols, while “Variable adherence to IPC” reflects inconsistencies of compliance, often the result of systemic pressures, such as socio-economic constraints, rather than individual or cultural judgements. When asked about the changes that they perceived in the IPC climates at their respective training hospitals from pre-COVID, during, and then post-COVID, the students gave very distinct answers; almost at opposite poles. The Lebanese students reflected on how the healthcare workers at their training hospitals reverted to a level of negligence regarding infection prevention and control post-COVID, while the Norwegian students portrayed a sense of hypervigilance among nurses in Norway post-COVID. For instance, one of the students said, “During COVID everyone was really compliant…we were helping at the frontlines at the time…in the first phase you could see that nurses were very diligent and scared of being infected…hazmats were used…bit by bit this control started to fade and then you could feel some of the nurses not caring anymore covering just their mouth for example but the management was really strict…after COVID people just do not care anymore at all” (S2, L). Another student corroborated in a separate interview by saying, “…the whole situation of the country just led people to be very mentally tired and they just want to breath…this is my explanation…they are not getting paid enough they can barely afford living…there many things on their mind besides COVID… this reflected on the whole infection climate…” (S7, L). On the other side, a Norwegian student said, “…till now nurses are under full protection, they are still scared to be infected…infection control is somewhat practiced religiously as the pandemic taught everyone a less to be learnt…” (S1, N). Another student also said, “…COVID was traumatic to everyone, nurses are still I guess affected by the COVID scare and this shows through the extensive measures nurses still take during each patient interaction…” (S5, N).

Organizational differences

The final theme that emerged related to differences in infection prevention protocols that Norwegian students discerned between their home country and training hospitals in Lebanon. The differences mainly focused on details such situations where using different types of PPEs for different situations. For instance one of the students said, “…I am used to always wearing a gown when entering a patients’ room especially in closed units and here it is not the case…” (S4, N). Another student also proclaimed, “…it is easier to follow protocol in Norway as everything is completely standardized while here it is a bit more volatile… like you would not know what to expect and this makes clinical training a bit more challenging…it should be fixed to be easier to navigate tricky situations…” (S1, N).

Discussion

This study examined the parallels and contrasts between student nurses’ perceptions, post COVID-19, of residing and practicing in two distinct cultural and organizational environments. Although there have been several reported studies on nurses’ perspectives during COVID-19, we were unable to find any that were cross-cultural, let alone among student nurses whose clinical training was affected and some were even put at the frontlines such as in the case of Lebanon. Thus this study aimed at exploring the cross-cultural perception of IPC climate in clinical training hospitals among Norwegian and Lebanese students post-COVID.

This study showed that many of the merits and challenges that student nurses experience regarding IPC can cross cultural boundaries, despite some peculiarities that are characteristic of the culture and situation of the country itself. Despite the students reporting an understanding on the importance of IPC, their engagement depends on structured guidance. Role ambiguity sometimes made the students undermine adherence to IPC, which stresses the need for supportive supervision. This is in line with research from China, Ethiopia, and India, in addition to another study by, which has found that students rated their perception of infection prevention and control measures to be average [10, 27–29]. These findings are to be anticipated given that the participants in this research are nursing students. Even though they are seniors, at some points, they might have not been fully aware of hospital IPC activities, considering they have little experience working in the clinical setting. In addition, nurses and other healthcare professionals get more comprehensive and in-depth experience in the healthcare setting, which helps them better understand the realities at a hospital [17]. If this study were to recruit lower academic year students the perception might have been even lower, yet higher academic year students have been shown to have lower compliance [30].

Interestingly, there is an apparent power dynamic when interpreting the theme “Culture of patient contact” through cross-cultural theoretical frameworks, specifically Hofstede [31]. Norwegian nursing students perceived Lebanese nursing students to be more interactive with patients, sometimes resulting in patient contact. Hofstede cultural dimensions, particularly uncertainty avoidance and power distance, influence the nurse’s attitudes towards clinical hierarchy and communication. In settings of high power distance, students may be inclined to maintain more formal interactions. In case of lower power distance, the students may maintain more egalitarian interactions. Even senior students uncertainty can be interpreted in terms of hierarchical structure. This theoretical framework provides insights of observed possible cross-cultural variations.

Besides that, the atmosphere around infection prevention may differ among hospitals, which might account for the present results [32]. Norwegian students in particular felt that the protocol is easier to navigate in Norway, considering that infection control measures and standard precautions are actually highly controlled. Either way, the results are significant and may suggest that training hospitals’ climates for infection prevention need to be improved [33]. In order for nursing to understand their duties in infection prevention, a training healthcare facility must guarantee that they participate in the hospital’s activities, such as regular trainings and orientations [34]. These findings emphasize the importance of role modeling and training to enhance IPC culture. Additionally, both Lebanese and Norwegian nursing students reported the lack of a role model. Nursing students often expect support from trainers and preceptors, and in regards to the findings of the study, those expectations were not met [13].

Inconsistent role modeling by nurses may influence a weaker IPC adherence, highlighting the importance of guidance and leadership for building a strong IPC climate. Observing inconsistencies in practices, as witnessed by the findings, can leave a negative perception of IPC importance, reinforcing the need for proper role modeling. Other research has also found a tendency for appraisals of organizational culture to deteriorate with more years of experience. For instance, the perspective on the patient safety culture among nurses in several Saudi hospitals decreased as the number of years of work experience went up [35]. Employees with less than five years of expertise demonstrated better hand hygiene adherence and firmly concurred that they can play a part in reducing HCAIs in the hospital than employees with greater experience, according to another investigation on the impact of healthcare roles and perspective on safety culture pertaining to preventing infection undertaken in the USA [36]. Students’ involvement in training hospitals has given them the chance to have contact with other health care personnel, care managers, and patients while also giving them enough time to become used to the clinical setting. Nursing students may have experienced more instances of defects or mistakes in the facility’s infection prevention and control due to their extended time spent in the clinical setting, which might have affected their viewpoint [10].

Another cross-cultural challenge that nursing students perceive regarding IPC is the patient workload that nurses are put under, which produces high amounts of stress and leaves room for a higher percentage of error and negligence. Workload is identified as an environment-oriented factor that influences infection control practices [37]. This is also in line with a previous study done in Saudi Arabia by Tumala, Almazan [32] found that the lowest rated aspects were psychological stability and supporting atmosphere. This highlights the interplay of environmental and structural factors that may influence physical support, overall affecting IPC climate. This research supports the claim that improving multidisciplinary interactions, collaboration, and a supportive environment can foster a positive IPC climate. According to a research by Livshiz-Riven, Nativ [38], inadequate psychological safety leads to more medical mistakes being made when treating patients. Cruz and Bashtawi discovered that among the critical concerns requiring immediate action are difficulties with the climate and an insufficiently supportive setting for infection management [33] .Moreover, researchers indicated that educators are in agreement for implementing new IPC practices [39].

On the other hand, Lebanese students reported that they felt the climate to transition from leniency to extreme control during COVID and then slowly back to leniency post-COVID. Norwegian students on the other hand reported a perpetuated hypervigilance in Norway, while they felt the more relaxed climate in Lebanon during their training. This can be attributed to the economic and social determinants that pose high psychological demands on the Lebanese nurses, thus precipitating possible instances of errors [40]. In addition, Lebanese students reported that the lack of equipment was a major challenge during COVID and post-COVID to maintain the IPC climate. This was also reflected upon by the Norwegian students. They reported dealing with this in their clinicals which hindered their hands-on experience, while they did not have to face this back home. This has been reported in a previous study by El Khoury, Talih [41]. These organizational differences reflect the national health policies in Lebanon and Norway. While Norway presents standard protocols and oversight, Lebanon is influenced by resource constraints, economic crises, and even improper system implementation [16, 42]. National healthcare policies in Lebanon are in need of critical attention and are constantly influenced by economic and political challenges [42]. The differences in IPC climate perceptions among Lebanese and Norwegian students emphasizes that even small system-level changes can significantly impact student’s compliance and undermining o f IPC importance.

The findings of this study contributes uniquely to the literature by being one of the first qualitative studies to explore cross-cultural perception of IPC climate between two cultural dict countries. Furthermore, the study focuses on perceptions post-COVID, adding an additional layer of novelty to the research. By comparing Lebanon and Norway, it captures how resource constraints, cultural norms, and varying healthcare structures influence IPC climate, providing insights rarely recorded in single-country studies.

Limitations

The limitation of this study was that the researchers were not able to acquire data from a bigger number of Norwegian students, who were from a single academic cohort. The practical limitation was because the Norwegian students participated in an exchange program to Lebanon. It would have been more desirable to have a larger pool of students to have a better maximum variation sampling, however saturation was reached. Thus, the small sample size may have limited the extent of transferability and generalizability. Cultural interpretation bias may have been introduced, as the cultural background of the nursing students may have influenced their perceptions. Future research capturing a larger sample of students from multiple cohorts could enhance generalizability. Additionally, the absence of member checking as per Colaizzi’s method may limit confirmability. Furthermore, this may have been further limited as participants did not provide feedback on findings.

Conclusion

According to the study’s results, it is clear that there is a necessity to enhance the infection prevention and control (IPC) climate in nursing student training facilities, independent of cultural or organizational variations. The study found that while both Lebanese and Norwegian nursing students believed IPC was important for patient safety, they were sometimes confused about their role in IPC during their earlier practice years and encountered conflicting role modeling from some practicing nurses. Also, both groups of students showed a strong need for IPC training among nurses and students. To address the raised challenges, we recommend the implementation of regular hands-on IPC projects, training under specialized nurses, structured orientations programs, and institutional policies that support a positive IPC climate.

Recommendations

Training hospitals should emphasize IPC training for both nursing students and working nurses to guarantee that they completely grasp their role and the necessity of IPC for patient safety. Hospital managers should give frequent IPC training and orientations, as well as create a supportive and consistent IPC culture that motivates healthcare professionals to comply. To lessen the possibility of mistakes and neglect, it is also critical to manage nurses’ workload and stress levels. Furthermore, it is suggested that future research on IPC views among nursing students and practicing nurses be performed in order to get a better understanding of IPC culture across diverse cultures and circumstances. These investigations can help improve IPC procedures and training for healthcare personnel, thereby enhancing patient safety and avoiding healthcare-associated infections. For instance, exploring patient contact culture in Lebanon is an interesting finding to pursue.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

COVID-19

Corona Virus Disease 2019

IPC

Infection Prevention and Control

Author contributions

The manuscript has been conceptualized and designed by RN, MF, SA, AS, and AM. MF wrote the proposal and developed the manuscript. AK contributed substantially to the refinement of the study methodology and to the critical revision of the manuscript. RN, MF, SA, AS, AM, and AK contributed to data validation and analysis as well as reviewing the final draft and rewriting sections in the manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

All participants provided written consent after receiving thorough details about the study. The work described has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans. Beirut Arab University Institutional Review Board approval was acquired (IRB number: ECO-R-130).

Consent for publication

Not applicable.

Patient consent

Not applicable.

Competing interests

The authors declare no competing interests.