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Abstract

Background

Chronic kidney disease has become a significant global public health burden due to its increasing incidence, prevalence, and impact on quality of life. Worldwide, conservative management, kidney transplantation, and renal replacement therapy are employed to manage chronic kidney disease. However, in Ghana, conservative management and hemodialysis predominate, focusing on prolonging life while neglecting other supportive care needs. This study explored nurses’ knowledge of kidney supportive care and the measures they adopt to identify and manage the psychological needs of patients with chronic kidney disease.

Methods

Exploratory descriptive qualitative design was employed. Eighteen nurses from a tertiary hospital dialysis unit in Ghana were purposively recruited. Face-to-face interviews were conducted using a semistructured guide, and thematic analysis was performed using Braun and Clarke's six-step qualitative data analysis method.

Results

Nurses’ practices were categorized into two main themes: awareness and emotional/psychological practices. The Awareness theme comprised five subthemes: expert communication, interdisciplinary teams, symptom management, realities, and management challenges. The emotional/psychological practices theme included three subthemes: establishing relationships, identifying needs, and addressing psychological issues.

Conclusion

The study revealed that while nurses in Ghanaian dialysis units possess some awareness of kidney support care, their practices are primarily centered on prolonging life rather than addressing holistic patient needs. Psychological and emotional support for chronic kidney disease patients is often informal and lacks structured guidelines. Limited resources and interdisciplinary collaboration hinder comprehensive kidney support care implementation. Strengthening nurses’ knowledge and integrating formal psychological support frameworks are crucial for improving patient-centred care in chronic disease management.

Keywords

chronic kidney disease conservative therapy end-stage renal disease haemodialysis kidney supportive care

Introduction

Chronic kidney disease (CKD) has become a significant global public health challenge, with rising prevalence, incidence, and impact on quality of life. According to the Global Burden of Disease, the global prevalence of CKD increased by 33% between 1990 and 2017 (Francis et al., 2024). Currently, approximately one in 10 adults worldwide, totaling over 800 million individuals, are affected by CKD, with a higher prevalence observed among the elderly and those with diabetes mellitus or hypertension (Kovesdy, 2022).

Research indicates that individuals of African descent face an elevated risk of CKD occurrence and progression to end-stage renal disease (ESRD) (Kaze et al., 2018). The prevalence of CKD varies across regions, with estimates ranging from 6.4% to 8.7% in South Africa, 10.7% to 13.9% in sub-Saharan Africa, and as high as 46.9% in Ghana (Hariparshad et al., 2023; Stanifer et al., 2014). Alarmingly, CKD is the third fastest-growing cause of death globally and is projected to become the fifth leading cause of years of life lost by 2040 (Foreman et al., 2018).

Management strategies for CKD include conservative therapy, renal replacement therapy, and kidney transplantation (KT). However, KT remains limited in Ghana and other resource-constrained settings (Okyere et al., 2022). According to the 2017 Ghana Renal Registry, 96.2% of CKD patients in the country underwent hemodialysis, 0.3% received peritoneal dialysis, and only 3.5% underwent KT (Tannor et al., 2023).

Historically, healthcare approaches to managing CKD have primarily focused on physiological aspects, such as blood pressure control, glycemic management, and hemodialysis. While these interventions are crucial, they often overlook the broader challenges faced by patients with CKD, including emotional distress, reduced quality of life, and the complexities of long-term treatment regimens.

Kidney Supportive Care (KSC), also known as Renal Supportive Care, aims to bridge these gaps by providing symptom management and improving the overall wellbeing of patients with CKD. KSC integrates specialist palliative care interventions for individuals with advanced kidney disease, addressing both physical and psychosocial needs (Gelfand et al., 2020). The KSC model consists of five core domains: symptom management, expert communication, interdisciplinary team support, comprehensive conservative care, and end-of-life care.

While KSC is well-established in high-income countries such as Canada, the United States, Australia, New Zealand, and Hong Kong, its adoption remains limited in Africa (Gelfand et al., 2020). More broadly, KSC remains underdeveloped and insufficiently integrated into kidney care across low, middle, and even high-income countries (Davison et al., 2023). Given its holistic approach, KSC plays a crucial role in addressing the substantial symptom burden experienced by patients with CKD throughout their illness trajectory, regardless of whether they receive life-prolonging therapies (Ofosu-Poku et al., 2020).

Despite advances in medical technology and treatment, a significant gap persists in the provision of comprehensive KSC for patients with CKD. Conventional care models remain predominantly disease-centered, failing to adequately address patients’ multifaceted needs, which results in suboptimal outcomes and diminished quality of life (Bachynski et al., 2023; O'Dea et al., 2022). Two critical gaps in CKD care are particularly pressing: limited patient education and insufficient psychological support. Addressing these deficiencies is essential for ensuring a more patient-centered and holistic approach to CKD management.

Limited Patient Education and Empowerment

Patients with CKD often lack sufficient knowledge about their condition, which can lead to poor self-management and delayed interventions. Targeted educational programs are essential to empower patients with the information needed to actively participate in their care, make informed decisions, and adhere to treatment regimens. A study in Ghana revealed that many patients with CKD referred for supportive care were unaware of its purpose and benefits, underscoring a critical gap in KSC education (Sobels et al., 2022; Tavares et al., 2020). This study aimed to assess nurses’ awareness of KSC and its impact on patient management.

Insufficient Psychological Support

CKD significantly affects patients’ mental wellbeing, often leading to anxiety, depression, and stress. However, existing healthcare systems tend to overlook the psychological aspects of care, highlighting the need for integrated KSC approaches that enhance coping mechanisms, reduce emotional distress, and improve patient resilience. Addressing the multifaceted challenges of CKD requires a paradigm shift toward a patient-centered, comprehensive care model.

By recognizing and addressing deficiencies in patient education, physical care, and psychological support, healthcare systems can improve outcomes for patients with CKD. This study explores KSC practices among nurses managing patients with CKD in a Ghanaian hospital, with the goal of bridging gaps in patient education and psychological support.

Literature Review

Prevalence of CKD

According to kidney disease: Improving Global Outcomes, CKD is defined as kidney damage lasting ≥3 months, characterized by structural or functional abnormalities with or without a decreased glomerular filtration rate (GFR), or a GFR <60 mL/min/1.73m² for ≥3 months, with or without kidney damage (Webster et al., 2017). CKD is classified into five distinct stages based on GFR, with stage five ESRD representing kidney failure, where GFR falls below 15 mL/min/1.73m², necessitating hemodialysis or KT.

Effectiveness and Application of KSC

Supportive care in general significantly reduces symptom burden, enhancing patients’ overall quality of life. KSC, in particular, plays a crucial role in alleviating common comorbidities such as anxiety, depression, and fatigue in individuals with CKD (Baudry et al., 2023). KSC contributes to improved patient outcomes increased patient satisfaction and enhanced treatment adherence (Bennett et al., 2025).

KSC which is a holistic approach recognizes the complex interplay of physical, emotional, and psychological factors in patient wellbeing, ultimately fostering better health outcomes and a more positive patient experience (Baudry et al., 2023; Bennett et al., 2025; Dhakal et al., 2024). A systematic review and meta-analysis demonstrated that nurse-led KSC significantly improved patient outcomes, including better management of blood pressure, lipid profiles, and glycaemic control in patients with CKD (McCrory et al., 2018). Reports from previous studies suggest that KSC reduced hospital admissions and costs, facilitated better patient–clinician communication, and improved symptom management among patients with CKD (Dharmagunawardene et al., 2025a). These studies highlighted the effectiveness of KSC interventions in improving patient outcomes, especially in end-of-life care and symptom management (Dharmagunawardene et al., 2025b).

Nurses’ Awareness: According to Ng et al. (2023a), nurses demonstrate knowledge of KSC through their involvement in symptom management for patients with CKD. However, while this has long been the case, the study highlights the need for nurse-led research to advance symptom science, alongside the development of guidelines that clearly define the roles of multidisciplinary team members.

A recent study on nurses’ roles in KSC identified a knowledge gap in symptom management, emphasizing the need for continued education for practising nurses. It also recommended incorporating professional education on KSC symptom management into postbasic training as a core competency (Ng-Brown et al., 2023). These recommendations align with findings from a study conducted at a teaching hospital in Ghana, which advocated for the expansion of KSC education within the curricula of health and allied health courses (Okyere & Kissah-Korsah, 2022).

Research from selected Canadian dialysis centers further identified a knowledge gap as a key contextual factor affecting KSC practices, particularly in engaging patients in KSC discussions. Such conversations are facilitated when healthcare providers are well-versed or have a strong understanding of the subject, and when institutions allocate financial support to KSC programs (Bachynski et al., 2023).

A study conducted in teaching hospitals in Rwanda reported that inadequate nursing practices in CKD and KSC management were linked to nurses’ limited understanding of the field, negatively impacting patient outcomes (Gapira, 2019). These findings align or are congruent with a cross-sectional study in Tanzania, which revealed that 59.4% of participants had minimal knowledge of CKD and KSC, while 72.4% of nurses were unfamiliar with the nutritional needs of patients with CKD (Munuo et al., 2016). Even in some developed countries, studies have indicated gaps in nurses’ knowledge regarding CKD and dialysis management, particularly among those with limited experience or education in nephrology nursing (Bennett et al., 2025; Rostoker et al., 2024).

Psychological Practices

CKD places a significant psychological burden on patients, affecting various aspects of their lives, including intimacy, social interactions, and work-related matters. These challenges contribute to substantial physical and emotional strain (O’Dea et al., 2022). Many patients with CKD frequently experience mental health disorders, particularly depression, which is associated with poor health outcomes. Depression has been linked to prolonged hospital stays, increased suicide rates, and higher mortality. Additionally, it often coexists with pain and fatigue, forming a distressing cluster of symptoms that patients consistently describe as highly burdensome (Gelfand et al., 2020). Anxiety is especially prevalent among hemodialysis patients and those undergoing conservative management for CKD, with reported rates as high as 52% and 54%, respectively. According to Bioma et al. (2019), financial hardships, recurrent hospital stays, time constraints, and future uncertainty are risk factors for psychological issues in dialysis patients.

Nurses play a crucial role in ensuring effective collaboration among members of the multidisciplinary treatment team. Additionally, patients can benefit from engaging in physical activity programs, support groups, rehabilitation activities, and educational initiatives. These interventions help patients build new support networks, gain social recognition and appreciation, and reduce the risk of social withdrawal and isolation. For those experiencing anxiety and depression, individualized psychotherapy is recommended (Gerogianni & Babatsikou, 2014)

Research Question

What do nurses know about KSC and how do they identify and address the psychological and emotional needs of patients with CKD?

Method

Study Design

This study employed a qualitative exploratory descriptive design to examine nurses’ awareness and practice in addressing the psychological needs of patients with CKD. This approach was chosen as it provides in-depth and comprehensive insights from respondents, allowing for a richer understanding of their experiences and perspectives.

Study Setting

The study was conducted at the Dialysis Unit of a tertiary care hospital in Ghana. This unit offers comprehensive outpatient and inpatient conventional dialysis services to patients from Accra and surrounding areas. The unit's infrastructure comprises a large open space divided into distinct sections, including the patient treatment area, procedure area, nurses’ station, unit stores, and staff changing room. Additional facilities such as the unit pharmacy, accounts office, and water treatment plant are located outside the unit.

The unit operates with a multidisciplinary team of approximately 35 staff members, including registered general nurses, enrolled nurses, and other healthcare professionals. Staff work in shifts, ensuring at least three dialysis nurses are available per shift. The unit operates 24/7, 6 days a week (Monday–Saturday), with an average daily patient census of 20, amounting to approximately 480 patients per month. Specialist support is provided by nephrologists, dialysis specialists, medical officers, residents, and house officers (on rotation). Additionally, the unit has two biomedical engineers responsible for machine maintenance, as well as a psychologist and a dietitian who provide regular patient consultations.

Operational Definitions

Caregiver: All nurses providing care to patients with CKD.

ESRD: The late stage of CKD or the stage of kidney failure where the glomerular filtration rate is below 15 mL/min/1.73 m².

Practices: Refers to an individual's insights, experiences, actions, and interventions related to a subject matter.

Quality of life: A subjective state of health in which an individual experiences physical, psychological, emotional, social, and spiritual wellbeing.

Study Population and Sampling

The study population comprised of nurses who had worked in the Dialysis Unit for at least 1 year. A total of 35 nurses were responsible for managing patients with ESRD receiving dialysis at the facility. This population was selected because of their training, observational experience, and hands-on practice in managing patients with CKD.

A total of 18 participants were recruited using purposive sampling, a nonprobability sampling technique. The researcher selected participants based on predefined criteria, including their specialist knowledge of the research topic, capacity, and willingness to participate. This method was chosen as it allows for an in-depth exploration of participants’ experiences, emotions, and perspectives—insights that may not be easily captured through quantitative research. Additionally, purposive sampling is cost-effective, time-efficient, and flexible.

The final sample size of 18 was determined based on data saturation, which was reached when no new codes or themes emerged from the interviews, indicating that further data collection would not yield additional insights. Nurses who were on rotation and those who met the inclusion criteria but were unwilling to participate after initial interaction were excluded from the study.

Data Collection Instrument

Data were collected through face-to-face semistructured interviews conducted between April 16 and April 22, 2024. The interview guide included sections on sociodemographic information and open-ended questions exploring nurses’ awareness of KSC and their practices in addressing psychological challenges faced by patients with CKD. To ensure clarity, relevance, and comprehensiveness, the interview guide was pretested with five (5) dialysis nurses (from a different medical establishment which is a quaternary-level hospital in Ghana) who met the study's inclusion criteria. Their feedback helped refine the questions, ensuring their appropriateness for the study (Malmqvist et al., 2019).

Data Collection Technique and Procedure

Before data collection, permission was obtained from the nursing officer in charge of the Dialysis Unit through a phone call on April 12, 2024, followed by a formal written request on April 16, 2024. This request was accompanied by ethical clearance documentation from the institutional review board. The nursing officer provided the staff list and duty roster, which helped identify nurses who met the inclusion criteria. Selected staff members who were off duty were contacted via phone to determine their willingness to participate and clarify any concerns. These calls did not imply automatic participation but allowed potential participants time to reconsider and provide feedback on their involvement.

Since the dialysis unit does not have a dedicated conference room, the unit nurse manager offered her office for use throughout the interview sessions.

The entire data collection process lasted 7 days (April 16–22, 2024). Participants were assured of anonymity and confidentiality, after which they signed a written informed consent form. The face-to-face interviews were audiorecorded with participants’ consent using the structured interview guide. Each interview lasted between 15 and 20 min.

Ethical Approval and Consent to Participate

Ethical approval for the study was granted by the Institutional Review Board of the study site, with approval number MH-IRB/MSHP/IPN/870/24, on April 8, 2024. The study objectives and details were clearly explained to all participants. They were informed that (1) participation was voluntary; (2) they had the right to withdraw at any time without facing any consequences; (3) the study posed no physical, social, or psychological risks; and (4) their identities would remain confidential throughout the research process. Following comprehensive explanations, eligible participants who expressed willingness to participate in the study provided written informed consent prior to recruitment. The study protocol ensured strict adherence to privacy and confidentiality principles, safeguarding participants’ trust and wellbeing throughout the research process.

Data Analysis

The authors manually analyzed the data using Braun and Clarke's (2006) six-step thematic analysis framework. The process involved the following phases:

Familiarization with the Data: Each interview recording was carefully listened to and transcribed verbatim. The transcriptions were then reviewed to identify relevant information addressing the research questions. This step was followed by generating Initial Codes: The entire dataset was systematically examined, and key data items were assigned concise but meaningful codes, ensuring that underlying patterns were captured. Themes were then generated as coded data were analyzed for commonalities and grouped into meaningful categories. Similar codes were merged, and representative codes were elevated to subthemes or main themes. Potential themes were recursively reviewed against the coded data and the overall dataset. Some preliminary themes were consolidated as subthemes under the broader KSC awareness theme. Two overarching themes emerged from the analysis namely awareness of KSC and psychological/emotional practices. These were further divided into eight sub-themes. The final themes and subthemes were compiled into a comprehensive report, providing a clear and structured narrative of the dataset.

Research Rigor

To ensure the trustworthiness of the study, the researcher followed Lincoln and Guba's (1986) criteria for validity in qualitative research.

Credibility was ensured by aligning the interview guide with the research objectives. The guide was reviewed and approved by the supervisor to prevent bias and enhance the relevance of questions (Korstjens & Moser, 2018). Additionally, data saturation was reached, and findings were shared with participants for verification, allowing them to clarify meanings, correct errors, or provide additional insights.

Transferability was achieved by providing a detailed description of the research process, including the study setting, participant selection, and data collection procedures, to allow replication in similar contexts (Schwandt et al., 2007). Confirmability and Dependability were maintained through comprehensive documentation of the research methodology, including a transparent account of the data collection and analysis process, ensuring consistency and reliability.

Sociodemographic Profiles of Study Participants

Majority of the respondents were females (13) compared to males (5). The educational level was distributed as, undergraduate education (15), Master's degree (2), and diploma (1). There were six different ranks among the nurses and they were, Nursing Assistant Clinical (NAC) (2), Senior Nursing Assistant Clinical (SNAC) (2), Staff Nurse (SN) (1), Nursing Officer (NO) (8) Senior Nursing Officer (SNO) (4), and Deputy Director of Nursing Services (DDNS) (1). Six out of the 18 participants had practised nursing for more than 10 years, while the majority (12) have less than 10 years working experience as a nurse. It was observed that no participant included in the study had worked in the dialysis unit for more than 10 years, although the majority of participants (10) had worked there between (5–10) years. All the participants with the exception of one indicated they had received CKD management training, either on-the-job training (7), formal training (7) or both formal and on-job training (3). Table 1 gives a detailed profile of individual respondents.

Table 1.

Sociodemographic Profile of Study Participants.

Respondent ID	Age	Gender	Level of education	Rank	Years working in the dialysis unit	Years of nursing experience	Training, type
KSC-N1	30–35	Female	Undergraduate	NO	6–10	9	Yes, formal
KSC-N2	30–35	Female	Undergraduate	NO	6–10	8	Yes, formal
KSC-N3	30–35	Female	Undergraduate	NO	6–10	10	Yes, formal
KSC-N4	30–35	Female	Undergraduate	SNAC	1–5	9	Yes, on-the-job training
KSC-N5	30–35	Female	Undergraduate	NAC	6–10	13	Yes, on-the-job Training
KSC-N6	40–45	Female	Undergraduate	SNO	6–10	14	Yes, formal
KSC-N7	40–45	Male	Undergraduate	NO	6–10	1	Yes, both formal and on-the-job training
KSC-N8	40–45	Female	Master's	DDNS	1–5	20	No
KSC-N9	30–35	Male	Undergraduate	SNO	1–5	7	Yes, on-the-job training
KSC-N10	26–30	Female	Undergraduate	NO	1–5	3	Yes, both formal and on-the-job training
KSC-N11	30–35	Female	Undergraduate	SNO	1–5	13	Yes, formal
KSC-N12	30–35	Female	Undergraduate	NO	1–5	5	Yes, both formal and on-the-job training
KSC-N13	30–35	Female	Undergraduate	NO	6–10	8	Yes, formal
KSC-N14	36–40	Female	Master's	SNO	1–5	16	Yes, formal
KSC-N15	30–35	Male	Undergraduate	NO	6–10	9	Yes, on-the-job training
KSC-N16	26–30	Female	Diploma	SN	1–5	4	Yes, on-the-job training
KSC-N17	30–35	Male	Undergraduate	SNAC	1–5	4	Yes, on-the-job training
KSC-N18	30–35	Male	Undergraduate	NO	1–5	6	Yes, on-the-job training

DDNS=Deputy Director of Nursing Services; KSC= Kidney Supportive Care; NO=Nursing Officer; NAC=Nursing Assistant Clinical; SNAC=Senior Nursing Assistant Clinical; SNO=Senior Nursing Officer.

Themes and Subthemes

Two major themes namely awareness and emotional and psychological practices were produced after analysing the entire dataset from the interviews conducted. Eight corresponding subthemes were also identified which were: expert communication, interdisciplinary team support, symptoms management, realities of CKD, management challenges, establishing relationships, and identifying needs and psychological issues. Table 2 presents a summary of themes and subthemes.

Table 2.

Themes and Subthemes Derived From Interviews.

Themes	Subthemes
1. Awareness	1. Expert communication
	2. IDT
	3. Symptoms management
	4. Realities of CKD
	5. Management challenges
2. Emotional/psychological practices	1. Establishing relationships
	2. Identifying needs
	3. Psychological issues

CKD=Chronic Kidney Disease;IDT=Interdisciplinary team.

THEME 1: Nurses’ Awareness of KSC

The awareness theme encompasses knowledge of KSC and consists of codes aimed at assessing KSC domains. Participant responses on KSC knowledge were scrutinized for elements within the domains. Five subthemes were identified under the awareness/knowledge theme which were communication, Interdisciplinary Team (IDT) symptoms management realities of CKD and management challenges.

Subtheme 1: Expert Communication

Communication is a critical aspect of KSC and involves the interaction that occurs between patients and healthcare providers. Expert communication helps patient adapt well to changes in their health and lifestyle, adopt a positive attitude to life and improve wellbeing. In KSC, communication involves but is not limited to providing patients with regular treatment updates, shared decision making, prognosis awareness, and advance care planning. It takes into account not just giving information but ensuring the information is well received and understood. Thus patients are likely to communicate with, in their native language or language they are more comfortable with. Below are some excerpts from the interviews.

“Anytime they come for a session, we tell them If their condition is improving or they are deteriorating. If there is a need for them to go and see a doctor, we tell them.” (KSC-N18)

“So, it is hard to keep up with daily updates or weekly updates but for monthly updates, it is consistent a bit.” (KSC-N15)

“Sometimes we organise training and seminars between the staff and patients with the aim of communicating the disease process to help them avoid complications.” (KSC-N4, KSC-N5)

“So, I personally tend to talk to them every time I initiate dialysis so I will get you involved in your treatment.’’ (KSC-N12)

Although some participants confirmed they gave regular updates and discussed prognosis with the patient and families, others had contrasting views when asked how often they update their patients and families on their state of health and the progress of treatment.

“For this, I think we have not been doing well when they come, we just attend to them. We do not really update them on their progress and other things.” (KSC-N7)

“Unfortunately, because of time and staff constraints we are not able to engage patients on a regular basis regarding their care thus we tend to make all the decisions which are not fair to them.” (KSC-N8)

Subtheme 2: Interdisciplinary Team

In this study, participants mentioned that KSC involves team effort and is not limited to just the nurses and doctors. These patients have diverse needs some of which may arise due to complications or as a result of the disease progression. Although the nurses and doctors are the ones always with these patients the efforts of other members cannot be undermined. Participants expressed their knowledge of some health professionals and nonhealth professionals expected to form part of the IDT. Although all these personnel are needed to work together, they are hardly available thus nurses end up assuming such roles making them overwhelmed, and patients do not obtain the full benefits required. Below is what the nurses had to say about their knowledge of the categories of health workers who form the IDT.

“Honestly, I think it is all around, there should not be one specific person in the multidisciplinary team. The pharmacist is part, the orderlies as well who form part of supporting staff.” (KSC-N10)

“We need the pharmacist, I think we need all the fraternities within the hospital and we need the surgeons, the surgical team, we need them for the surgical procedures to be performed and then the medical team as well.” (KSC-6)

Some participants saw the KSC IDT to be all-around. Others were of the view that some members play a more vital role than others, making them assets to the team and should preferably be the first to interact with these patients. These are responses from participants when asked about the IDT.

“Essentially, I believe dieticians and psychologists play critical roles. I believe the initial point of contact should be the psychologist, and by that, I mean they should be on top of their game because when the news is conveyed to any of the patients, they do not take it lightly. They tend to break down psychologically, and they require psychological advice, which should be provided at least twice or three times per week. I believe they should always be required to meet with the psychologist to talk to them and appreciate their work. In addition to the dietician and psychologist, I believe the doctors and nurses are also important in helping them with their disease. We are coming in to manage.” (KSC-N12)

Apart from the IDT team, some participants also suggested the inclusion of religious heads like chaplains and Imams as part of the team to help cater for the spiritual needs of these patients. Below are responses on the need for the inclusion of religious heads in the management of patients.

“I think it will not be bad if the religious heads I mean the pastors and the Imams are part of the team because for now what we have is just the pharmacist.” (KSC-N11)

“So, per what we practise here we involve the clinical psychologist, the dietician, the pharmacist including the nurses but I think the chaplain should be part.” (KSC-N8)

Subtheme 3: Symptoms Management

In this study, participants shared their knowledge of what KSC entails and the diverse symptoms patients with KSC experience. Some of which are life-threatening and how they manage these symptoms. These symptoms may be physical, psychological, physiological, and sometimes issues of intimacy but the goal of managing these symptoms is to prolong life, relieve the discomfort associated with these symptoms and improve their quality of life. Without kidney transplantations, the survival rate among patients with CKD is minimized and death is inevitable making it a necessity for caregivers to help reduce complications that may prevent them from enjoying the quality of life.

“Ok, you helping minimize the signs and symptoms and sustaining those with kidney failure for a while before they pass on.” (KSC-N3)

“I know it is care rendered by nurses who work in the dialysis unit to usher our clients to a peaceful or let us say a serene death because most of them cannot afford kidney transplants so we just have to do dialysis for them till God decides to call them.” (KSC-N10)

Subtheme 4: Realities of CKD

Several participants in this study mentioned the financial difficulty patients and their families face when the diagnosis of CKD is made. Management involves a team approach, thus the need to be attended to by other members of the KSC team aside from the nephrologist like the dietician, psychologist, and vascular surgeons which all come at an additional cost. The cost of dialysis itself, their medications, monthly laboratory investigations and even transportation costs to and from the unit three times a week is a reason for these patients to be stressed out.

“… we all know dialysis is expensive and they need about three sessions in a week aside from that they need medications to keep their Haemoglobin (Hb) level up and also, they need medications to control their Blood Pressure (Bp) and other symptoms they are going through.” (KSC-N11)

“As I said earlier what they usually complain about are financial issues, that is their major problem because if they do not have money, they cannot have adequate dialysis sessions which affects their health, some patient's catheters are not functioning properly giving them poor clearance but because there cannot afford the cost arteriovenous fistula they depend solely on that.” (KSC-N4)

Other participants expressed their hope that this work would be published to draw the attention of the government and other stakeholders to help lessen the financial burden on these patients.

“I pray this study can get published so it can get the attention of the higher-ups in government so they support these patients financially or include their treatment on the national health insurance because kidney issues now have become very rampant and it is disheartening.” (KSC-N2)

Subtheme 5: Management Challenges

In this study, the majority of the challenges were identified as facility-based and a few related to the patients. Challenges with logistics and issues with staff training and staffing were some of the issues almost all participants mentioned. They expressed that some of them did not have the chance of being trained with regard to managing these patients. The nonexistence of guidelines makes it difficult with regard to what they should do in certain situations. Also, lack of logistics poses a major challenge making it difficult to provide the needed care. Aside from these challenges, some practices were identified to be “bad” and hinder the nurse–patient relationship's progress.

“One can be a knowledge deficit, so some of us are still not trained very well to render adequate and holistic care to them. Some of them come with a peculiar case and you need to have in-depth knowledge in the profession to be able to render care to them. That is one. Two is logistics, it is one of our problems because you need a lot of things in the working environment to ensure that patients receive adequate care. We do not have an adequate number of machines to meet the growing demand. Consumables are also not readily available even supplies for dressing are equally a problem. When you are looking for things to check blood pressures, instruments to check Hb and Random blood sugar (RBS) are all challenges we face here…” (KSC-N9)

“On my side, the difficulty comes in when you don’t know what to do, you can identify a problem but you don’t know what to do because there is no protocol. The quarters you have to report to and how to go about it, as a nurse you might use your general knowledge and reassurance to help them but it might not do much…” (KSC-N7)

Some respondents revealed that they avoid getting too close to their patients to prevent separation anxiety when the needs arise or prevent them from seeking financial support from them when they come on duty. While others avoid putting themselves in the shoes of these patients or getting too emotional when managing these patients. Below are some of the responses participants gave.

“When I came here, I was told we should not really get too close to the patient because some patients beg for money from the staff to help them do their dialysis and sometimes even when they relocate to a different centre, they still prefer to take instructions from their previous caregivers which is not helpful.” (KSC-N10)

THEME 2: Emotional/Psychological Practices

This theme delves into the emotional struggles experienced by patients with CKD and how healthcare providers are able to assist them. Subthemes within this domain include establishing relationships, which encompasses establishing rapport by increasing contact time with patients while assessing and identifying needs. These needs are anger, feelings of despair and future uncertainties. Additionally, offering emotional support through counseling, offering a listening ear and providing diversional therapy help address these challenges.

Subtheme 1: Establishing Relationships

Establishing cordial and professional relationships with your patients and getting to know your patients allows caregivers to provide the needed care because patients are able to voice out their issues and seek guidance while caregivers are able to detect changes in their patients and provide the needed support. Participants expressed how they are able to easily pick up subtle changes in their patients and how they help them overcome them.

“Usually, we do have a good relationship with them, both the patients and their relatives as well. Most of the time they come in when they are down, they do not talk. they are quiet, a regular person you think normally will be playful will come and not be talking … you have to know your patients and how they come.” (KSC-N17)

“So because the patients come here very often, we know how they behave, at times they come and they do not want to even talk some of them you see them even crying so we are able to pick it up easily because it is not just their first time of coming here…” (KSC-N11)

Subtheme 2: Emotional Support

Participants expressed how they support these patients overcome their emotional/psychological challenges when identified as follows:

“… you have to increase the contact time with them as a nurse as the nephrology nurse you have to increase the contact time with them so that you spend more time. You know sometimes you spend 30 minutes with your client sitting by them to have a conversation but I refer to the clinical psychologist where necessary.” (KSC-N15)

“You have to establish trust between the two of you and let the person open up, ask more questions probably from the onset the person might not want to open up but you have to initiate jokes or something I mean even if the person is not willing once a while.” (KSC-N12)

Discussion

This study explored nurses’ awareness of KSC and their role in identifying and managing the psychological and emotional challenges faced by patients with CKD. The findings indicate that while nurses demonstrated some understanding of KSC, there were inconsistencies in their responses, with some relying on impromptu thoughts, highlighting gaps in their knowledge. Nevertheless, they made efforts to address these gaps based on their clinical experience.

These findings align with previous studies that have identified knowledge gaps among nurses regarding KSC. A qualitative study in Canada highlighted this issue, emphasizing that inadequate knowledge can delay optimal palliative care services, potentially leading to CKD patients receiving insufficient end-of-life support (Bachynski et al., 2023). Similarly, a descriptive correlational study in Rwanda found a link between limited KSC knowledge and substandard nursing practices (Gapira et al., 2020). In Tanzania, a cross-sectional study reported that over half (59.4%) of nurses had inadequate knowledge of KSC, with 72.4% particularly lacking knowledge of patients with CKD nutritional requirements (Munuo et al., 2016).

Contrasting evidence exists, however. A cross-sectional study in Ghana found that nurses possessed adequate knowledge of palliative care, including KSC, with a positive correlation between knowledge levels and best practices (Owusu et al., 2022). Likewise, a nationwide survey in Taiwan revealed that nurses and other healthcare professionals demonstrated strong proficiency in KSC, particularly in symptom management and case vignettes (Tsai et al., 2017).

Nurses in this study attributed their knowledge gaps to insufficient refresher training, limiting their ability to provide comprehensive care. They also identified challenges in effectively communicating vital patient information, such as treatment updates, prognosis, and advance care planning, to both patients and caregivers (Tsai et al., 2017). A qualitative study in Taiwan similarly found that nephrology nurses struggled with initiating advance care planning due to inadequate knowledge and communication skills (Chen & Chiu-Chu, 2021). Additionally, a lack of confidence in interactions with both patients and other healthcare professionals was noted. Given that effective communication is closely linked to patient safety culture and health outcomes (Noviyanti et al., 2021), addressing these gaps is essential for improving the quality of care provided to patients with CKD.

In this study, nurses recognized that patients with CKD frequently experience emotional and psychological challenges, including anger, fear, mood swings, anxiety, and depression. This finding aligns with previous research highlighting the significant mental health burden associated with kidney disease. For instance, O’Dea et al. (2022) identified issues related to intimacy and social withdrawal among patients with CKD. Similarly, depression and suicidal thoughts are common due to uncertainties about health outcomes, chronic pain, and exhaustion (Gelfand et al., 2020). A qualitative study in India further revealed that thoughts of death often preoccupy patients with CKD, underscoring the need for mental health support (Powathil & Kr, 2023). In Egypt, a cross-sectional study reported that 39% of patients with ESKD undergoing hemodialysis experienced suicidal ideation (Hassan et al., 2019). Additionally, many hemodialysis patients report a lack of happiness, contentment, and hope, negatively affecting their quality of life (Sousa et al., 2019).

Financial concerns emerged as a significant source of distress among patients with CKD, consistent with findings from previous studies. The high cost of treatment often leads to embarrassment, particularly when patients rely on crowdfunding, social media appeals, or financial support from family and friends (Griva et al., 2020; Ng et al., 2023b). Furthermore, stigma, discrimination, and stereotyping exacerbate the mental health burden (Akokuwebe & Idemudia, 2022; Kanagaratnam et al., 2023). In Ghana, the financial strain is particularly severe due to the high cost of hemodialysis and the necessity for frequent treatment sessions to sustain life (Osei Appiah et al., 2022).

Despite these challenges, nurses in this study reported fostering strong relationships with patients with CKD, encouraging them to voice their concerns and seek support. A qualitative study in Ireland emphasized the importance of healthcare practitioners building close relationships with patients with CKD experiencing mental distress, as this facilitates personalized care and deeper insight into their struggles (Cogley et al., 2023). Effective communication and counseling techniques, such as Cognitive Behavioral Therapy and Motivational Interviewing, have been shown to build trust, support behavioral change, and improve adherence to dietary and medical regimens (Isoldi, 2020). Similarly, a cross-sectional study conducted in four Dutch hospitals recommended behavioral interventions, including social support systems, to enhance dietary and medical adherence while addressing patient anxiety (Cardol et al., 2023).

The nurses in this study emphasized the importance of continuous interaction, trust-building, and referrals to clinical psychologists when needed to address emotional and psychological distress. Individualized psychotherapy is widely recommended for patients with CKD experiencing anxiety and depression (Gerogianni & Babatsikou, 2014). Similarly, Nicholas (2016) advocated for integrating emotional and psychological support into routine patient care to enhance overall wellbeing (Nicholas, 2016).

Strengths and Limitations

A key strength of this study was its research design, particularly the use of face-to-face interviews, which allowed nurses to provide detailed responses based on their firsthand experiences with patients with CKD. However, the study was limited in scope, as it focused solely on nurses and did not include other essential members of the healthcare team. Since nurses are not the only professionals involved in direct patient care, caution should be exercised when generalizing the findings to other healthcare providers. Additionally, the study primarily reflects the perspectives of care providers rather than patients, limiting insights into the experiences and needs of patients with CKD themselves.

Implication for Practise

The findings of this study highlight critical gaps in nurses’ knowledge of KSC and their ability to effectively address the psychological and emotional needs of patients with CKD. These gaps have significant implications for clinical practice, healthcare policy, and nursing education. To enhance the quality of care for patients with CKD, healthcare institutions must prioritize continuous professional development and refresher training programs for nurses. Targeted training on KSC, including symptom management, advanced care planning, and effective communication strategies, is essential to bridge knowledge gaps and improve nursing practice. Moreover, integrating structured psychological support within routine CKD care can help address the high prevalence of anxiety, depression, and suicidal ideation among patients. Nurses should be empowered with evidence-based counseling techniques to foster trust, encourage treatment adherence, and mitigate emotional distress. Healthcare policymakers should consider developing standardized guidelines for KSC training among nurses to ensure consistency in knowledge and practice. Additionally, policies promoting interprofessional collaboration can improve communication between nurses and other healthcare providers, facilitating a holistic approach to patient care.

Conclusion

This study explored nurses’ awareness of KSC and their role in managing the psychological and emotional needs of patients with CKD in Ghana. While nurses demonstrated some understanding of KSC, knowledge gaps in symptom management, interdisciplinary collaboration, and communication were evident. These gaps, along with financial constraints and limited institutional support, hinder the effective delivery of holistic care. Despite challenges, nurses showed commitment to patient care, emphasizing the need for structured training, improved teamwork, and integrated psychological support. Addressing these gaps through policy changes and continuous education can enhance patient outcomes and ensure comprehensive CKD management. Future research should explore the impact of nurse-led interventions and strategies to improve KSC accessibility.

Supplemental Material

sj-docx-1-son-10.1177_23779608251350750 - Supplemental material for Exploring Nurses’ Supportive Care Practices for Managing Patients with Chronic Kidney Disease (CKD) in a Tertiary Care Facility in Ghana

Supplemental material, sj-docx-1-son-10.1177_23779608251350750 for Exploring Nurses’ Supportive Care Practices for Managing Patients with Chronic Kidney Disease (CKD) in a Tertiary Care Facility in Ghana by Joana Akpakli Addo and Vivian Efua Senoo-Dogbey in SAGE Open Nursing

Supplemental Material

sj-docx-2-son-10.1177_23779608251350750 - Supplemental material for Exploring Nurses’ Supportive Care Practices for Managing Patients with Chronic Kidney Disease (CKD) in a Tertiary Care Facility in Ghana

Supplemental material, sj-docx-2-son-10.1177_23779608251350750 for Exploring Nurses’ Supportive Care Practices for Managing Patients with Chronic Kidney Disease (CKD) in a Tertiary Care Facility in Ghana by Joana Akpakli Addo and Vivian Efua Senoo-Dogbey in SAGE Open Nursing

Footnotes

Abbreviations

Acknowledgements

The authors acknowledge the efforts and contributions of all the nurses who participated voluntarily in this study.

ORCID iD

Vivian Efua Senoo-Dogbey

Ethical Considerations

Ethics approval was obtained from the institutional review board of the facility where the study took place (MH-IRB/MSHP/IPN/870/24).

Consent to Participate

Informed consent was obtained from each participant with an assurance of anonymity and confidentiality.

Author Contributions

JAA was involved in conceptualization, methodology, resources, data curation, formal data analysis, writing—original draft, and writing—reviewing & editing; and VES-D in methodology, supervision, validation, visualization, writing—original draft, and writing—reviewing & editing.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

Data is published with this manuscript.

Supplemental Material

Supplemental material for this article is available online.

References

Akokuwebe

M. E.

Idemudia

E. S.

(2022). Knowledge and risk perceptions of chronic kidney disease risk factors among women of childbearing age in Lagos State, Nigeria: From a health demography approach. International Journal of Nephrology, 2022(1), 5511555. https://doi.org/10.1155/2022/5511555

Bachynski

J. C.

Duhn

Costa

I. G.

Plazas

P. C.

(2023). We’re not there yet”: Exploring contextual factors shaping Canadian dialysis nurses’ engagement in kidney supportive care. New Trends in Qualitative Research, 16, e789–e789. https://doi.org/10.36367/NTQR.16.2023.E789

Baudry

A. S.

Charton

Piessen

Vanlemmens

Cortot

Ceban

Anota

Christophe

(2023). Emotional distress, supportive care needs and age in the prediction of quality of life of cancer patients’ caregivers: A cross-sectional study. European Journal of Oncology Nursing, 64(March), 1–15. https://doi.org/10.1016/j.ejon.2023.102324

Bennett, P., Warren, M., Aydin, Z., Beige, J., Bowes, E., Cheung, M., Finderup, J., Gallego, D., Hecking, M., Hurst, H., King, J. M., Kleophas, W., Liossatou, A., Martins, P., Masià-Plana, A., Meuleman, Y., Neri, L., Noruišienė, E., Ortiz, J., … Tsukamoto, Y. (2025). Kidney Disease: Improving Global Outcomes (KDIGO) workshop on the nurse’s role in managing the symptoms of people receiving dialysis. Kidney International Reports, 10(2), 313–320. https://doi.org/10.1016/j.ekir.2024.11.029

Bioma, V., Ganu, V. J., Dey, D. I., Yorke, E., Adjei, P., Mate-Kole, M., & Mate-Kole, C. C. (2019). Psychological changes in Africans with kidney disease in Ghana: A comparison of haemodialysis patients and patients with chronic kidney disease not on dialysis. African Journal of Nephrology, 22(1), 21–27.

Braun

Clarke

(2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

Cardol

C. K.

Meuleman

van Middendorp

van der Boog

P. J.

Hilbrands

L. B.

Navis

Sijpkens

Y. W.

Sont

J. K.

Evers

A. W.

van Dijk

(2023). Psychological distress and self-management in CKD: A cross-sectional study. Kidney Medicine, 5(10), 100712. https://doi.org/10.1016/j.xkme.2023.100712

Chen

J.-O.

Chiu-Chu

(2021). Exploring the barriers faced by nephrology nurses in initiating patients with chronic kidney disease into advance care planning using focus-group interviews. Journal of Nursing Research, 29(6), e179. https://doi.org/10.1097/JNR.0000000000000462

Cogley

Carswell

Bramham

Smith

Holian

Conlon

D’Alton

(2023). Improving kidney care for people with severe mental health difficulties: A thematic analysis of twenty-two healthcare providers’ perspectives. Frontiers in Public Health, 28(11), 1225102. https://doi.org/10.3389/fpubh.2023.1225102

10.

Davison

S. N.

Wearne

Bagasha

Krause

(2023). Conservative Kidney Management and Kidney Supportive Care: Essential treatments for kidney failure. Medical Research Archives, 11(8). https://doi.org/10.18103/mra.v11i8.4222

11.

Dhakal

Chen

Wang

Mboineki

J. F.

Adhikari

(2024). Existing psychological supportive care interventions for cervical cancer patients: A systematic review and meta-analysis. BMC Public Health, 24(1), 1–24. https://doi.org/10.1186/s12889-024-18634-3

12.

Dharmagunawardene, D., Bowman, P., Avery, M., Greenfield, D., & Hinchcliff, R. (2025a). Factors influencing the establishment of hospital accreditation programs in low–and middle–income countries: A scoping review. Health Policy and Planning, 40(4), 496–517. https://doi.org/10.1093/heapol/czaf011

13.

Dharmagunawardene

Kularatna

Halahakone

Purtell

Bonner

Healy

H. G.

Senanayake

(2025b). Health system related kidney supportive care interventions for adults with chronic kidney disease: A systematic review. Journal of Renal Care, 51(1), 1–22, e12517. https://doi.org/10.1111/jorc.12517

14.

Foreman

K. J.

Marquez

Dolgert

Fukutaki

Fullman

McGaughey

Pletcher

M. A.

Smith

A. E.

Tang

Yuan

C.-W.

(2018). Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: Reference and alternative scenarios for 2016–40 for 195 countries and territories. The Lancet, 392(10159), 2052–2090. https://doi.org/10.1016/S0140-6736(18)31694-5

15.

Francis

Harhay

M. N.

Ong

Tummalapalli

S. L.

Ortiz

Fogo

A. B.

Fliser

Roy-Chaudhury

Fontana

Nangaku

(2024). Chronic kidney disease and the global public health agenda: An international consensus. Nature Reviews Nephrology, 20(7), 473–485. https://doi.org/10.1038/s41581-024-00820-6

16.

Gapira

B. E

. (2019). Knowledge and practices of nurses regarding inpatient management of chronic kidney disease at selected referral at hospitals in Rwanda [PhD Thesis]. University of Rwanda.

17.

Gapira

B. E.

Chironda

Ndahayo

Theos

M. P. M.

Tuyisenge

M. J.

Rajeswaran

(2020). Knowledge related to chronic kidney disease (CKD) and perceptions on inpatient management practices among nurses at selected referral hospitals in Rwanda: A non-experimental descriptive correlational study. International Journal of Africa Nursing Sciences, 13, 100203. https://doi.org/10.1016/j.ijans.2020.100203

18.

Gelfand

S. L.

Scherer

J. S.

Koncicki

H. M.

(2020). Kidney supportive care: Core curriculum 2020. American Journal of Kidney Diseases, 75(5), 793–806. https://doi.org/10.1053/J.AJKD.2019.10.016

19.

Gerogianni

S. K.

Babatsikou

F. P.

(2014). Psychological aspects in chronic renal failure. Health Science Journal, 8(2), 205–214.

20.

Griva

Seow

P. S.

Seow

T. Y.-Y.

Goh

Z. S.

Choo

J. C. J.

Foo

Newman

(2020). Patient-related barriers to timely dialysis access preparation: A qualitative study of the perspectives of patients, family members, and health care providers. Kidney Medicine, 2(1), 29–41. https://doi.org/10.1016/j.xkme.2019.10.011

21.

Hariparshad

Bhimma

Nandlal

Jembere

Naicker

Assounga

(2023). The prevalence of chronic kidney disease in South Africa—limitations of studies comparing prevalence with sub-Saharan Africa, Africa, and globally. BMC Nephrology, 24(1). https://doi.org/10.1186/S12882-023-03109-1

22.

Hassan

Taha

Mahmoud

(2019). Psychological problems among patients with end-stage renal failure undergoing hemodialysis. Mansoura Nursing Journal, 6(2), 1–10. https://doi.org/10.21608/mnj.2019.176348

23.

Isoldi

K. K.

(2020). Counselling approaches, nutrition in kidney disease (pp. 635–651). Human Press.

24.

Kanagaratnam

Zwi

Webster

A. C.

Isautier

Lambert

Shepherd

H. L.

McCaffery

Sud

Muscat

D. M.

(2023). Interventions to support decision-making, health literacy and self-management in ethnic-minority adults living with chronic kidney disease: A systematic review. Clinical Kidney Journal, 16(6), 914–927. https://doi.org/10.1093/ckj/sfac276

25.

Kaze

A. D.

Ilori

Jaar

B. G.

Echouffo-Tcheugui

J. B.

(2018). Burden of chronic kidney disease on the African continent: A systematic review and meta-analysis. BMC Nephrology, 2018(19), 125–136. https://doi.org/10.1186/s12882-017-0808-y

26.

Korstjens

Moser

(2018). Series: Practical guidance to qualitative research. Part 4: Trustworthiness and publishing. European Journal of General Practice, 24(1), 120–124. https://doi.org/10.1080/13814788.2017.1375092

27.

Kovesdy

C. P.

(2022). Epidemiology of chronic kidney disease: An update 2022. Kidney International Supplements, 12(1), 7. https://doi.org/10.1016/J.KISU.2021.11.003

28.

Lincoln

Y. S.

Guba

E. G.

(1986). But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New Directions for Program Evaluation, 1986(30), 73–84. https://doi.org/10.1002/ev.1427

29.

Malmqvist

Hellberg

Möllås

Rose

Shevlin

(2019). Conducting the pilot study: A neglected part of the research process? Methodological findings supporting the importance of piloting in qualitative research studies. International Journal of Qualitative Methods, 18(2019), 1–11. https://doi.org/10.1177/1609406919878341

30.

McCrory

Patton

Moore

O’Connor

Nugent

(2018). The impact of advanced nurse practitioners on patient outcomes in chronic kidney disease: A systematic review. Journal of Renal Care, 44(4), 197–209. https://doi.org/10.1111/jorc.12245

31.

Munuo

A. E.

Mugendi

B. W.

Kisanga

O. A.

Otieno

G. O.

(2016). Nutrition knowledge, attitudes and practices among healthcare workers in management of chronic kidney diseases in selected hospitals in Dar es Salaam, Tanzania; a cross-sectional study. BMC Nutrition, 2(6), 1–7. https://doi.org/10.1186/s40795-016-0045-y

32.

Ng, M. S. N., Brown, E. A., Cheung, M., Figueiredo, A. E., Hurst, H., King, J. M., Mehrotra, R., Pryor, L., Walker, R. C., Wasylynuk, B. A., & Bennett, P. N. (2023a). The role of nephrology nurses in symptom management - reflections on the kidney disease: Improving global outcomes controversies conference on symptom-based complications in dialysis care. Kidney International Reports, 8(10), 1903–1906. https://doi.org/10.1016/j.ekir.2023.08.025

33.

M. S. N.

Chan

D. N. S.

W. K. W.

(2023b). Health inequity associated with financial hardship among patients with kidney failure. Plos One, 18(6), e0287510. https://doi.org/10.1016/j.ekir.2023.08.025

34.

Nicholas

(2016). Integrating emotional and psychological support into the end-stage renal disease pathway: A protocol for mixed methods research to identify patients’ lower-level support needs and how these can most effectively be addressed.

35.

Noviyanti

L. W.

Ahsan

Sudartya

T. S.

(2021). Exploring the relationship between nurses’ communication satisfaction and patient safety culture. Journal of public health research, 10(2), 1–16. https://doi.org/10.4081/jphr.2021.2225

36.

O’Dea

Gedye

Jago

Paterson

(2022). Identifying the unmet supportive care needs of people affected by kidney cancer: A systematic review. Journal of Cancer Survivorship, 16(6), 1279–1295. https://doi.org/10.1007/S11764-021-01113-8/METRICS

37.

Ofosu-Poku

Owusu-Ansah

Antwi

(2020). Referral of patients with nonmalignant chronic diseases to specialist palliative care: A study in a teaching hospital in Ghana. International Journal of Chronic Diseases, 2020(15), 8432956. https://doi.org/10.1155/2020/8432956

38.

Okyere

Kissah-Korsah

(2022). Opportunities for integrating palliative care in Ghana. Sage Open Nursing, 8, 23779608221143271.

39.

Okyere

Essuman

Attakora

Serwaa

Donkoh

I. E.

Ephraim

R. K. D.

(2022). Conservative therapy is associated with worse clinical features and biochemical derangements than renal replacement therapy: a retrospective study in Kumasi, Ghana. BMC Nephrology, 23(1). https://doi.org/10.1186/S12882-022-02951-Z

40.

Osei Appiah

Amertil

N. P.

Oti-Boadi

Georgina Intsiful

Hakami

(2022). Experiences of patients with end stage renal disease prior to and during dialysis therapy at greater Accra regional hospital. Cogent Public Health, 9(1), 2146301. https://doi.org/10.1080/27707571.2022.2146301

41.

Owusu

A. B.

Adam

A. B.

Setorglo

Anim

M. T.

Bonsu

(2022). Palliative care practices among nurses at Cape Coast Teaching Hospital, Ghana: A cross-sectional study. International Journal of Africa Nursing Sciences, 17(1), 100454. https://doi.org/10.1016/j.ijans.2022.100454

42.

Powathil

G. G.

(2023). The experience of living with a chronic illness: A qualitative study among end-stage renal disease patients. Journal of Social Work in End-of-Life & Palliative Care, 19(3), 190–208. https://doi.org/10.1080/15524256.2023.2229034

43.

Rostoker

Tröster

Masià-Plana

Ashworth

Perampaladas

(2024). Dialysis nurse demand in Europe: An estimated prediction based on modelling. Clinical Kidney Journal, 17(7), 1–8. https://doi.org/10.1093/ckj/sfae162

44.

Schwandt

T. A.

Lincoln

Y. S.

Guba

E. G.

(2007). Judging interpretations: But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New Directions for Evaluation, 2007(114), 11–25. https://doi.org/10.1002/ev.223

45.

Sobels

Best

Chadban

Pais

(2022). End stage kidney disease patient experiences of renal supportive care in an Australian teaching hospital—a qualitative study. Journal of Pain and Symptom Management, 63(5), 737–746. https://doi.org/10.1016/j.jpainsymman.2021.12.024

46.

Sousa

Ribeiro

Paul

Costa

Miranda

Ribeiro

Figueiredo

(2019). Social support and treatment adherence in patients with end-stage renal disease: A systematic review. Seminars in Dialysis, 32(6), 562–574. https://doi.org/10.1111/sdi.12831

47.

Stanifer

J. W.

Jing

Tolan

Helmke

Mukerjee

Naicker

Patel

(2014). The epidemiology of chronic kidney disease in sub-Saharan Africa: A systematic review and meta-analysis. The Lancet Global Health, 2(3), e174–e181. https://doi.org/10.1016/S2214-109X(14)70002-6

48.

Tannor

E. K.

Hutton-Mensah

Opare-Addo

Agyei

M. K.

Gyan

K. F.

Inusah

A.-J.

Nyann

B. I.

Amo-Antwi

Luyckx

Okpechi

(2023). Fifty years of hemodialysis in Ghana—current status, utilization and cost of dialysis services. BMC Health Services Research, 23(1), 1170. https://doi.org/10.1186/s12913-023-10154-x

49.

Tavares

A. P. d. S.

Santos

C. G. d. S.

Tzanno-Martins

Barros

Silva

A. M. M. d.

Lotaif

Souza

J. V. L.

(2020). Kidney supportive care: An update of the current state of the art of palliative care in CKD patients. Brazilian Journal of Nephrology, 43(1), 74–87. https://doi.org/10.1590/2175-8239-jbn-2020-0017

50.

Tsai

H.-B.

Chao

C.-T.

Huang

J.-W.

Chang

R.-E.

Hung

K.-Y.

(2017). A nationwide survey of healthcare personnel’s attitude, knowledge, and interest toward renal supportive care in Taiwan. PeerJ, 7(5), e3540. https://doi.org/10.7717/peerj.3540

51.

Webster

A. C.

Nagler

E. V.

Morton

R. L.

Masson

(2017). Chronic kidney disease. The Lancet, 389(10075), 1238–1252. https://doi.org/10.1016/S0140-6736(16)32064-5

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