Understanding perceived quality of nursing care among adults receiving haemodialysis in Northern Ghana: A qualitative inquiry

Abstract

INTRODUCTION: Patients with End-Stage Kidney Disease (ESKD) who undergo haemodialysis (HD) frequently encounter significant physical and psychosocial challenges. The quality of nursing care plays a crucial role in determining patient outcomes. However, there is limited understanding of how this patient population in resource-constrained settings in Northern Ghana perceive the quality of nursing care during treatment. Also, the delivery of patient-centered care for patients undergoing HD is challenged by systemic issues such as limited dialysis machines, frequent breakdown of equipment, poor water supply and staff shortages. AIM: This study explored the perceptions of quality nursing care among adults on HD treatment in Northern Ghana. METHODS: This exploratory descriptive qualitative study was conducted at Tamale Teaching Hospital, the only public referral dialysis center in Northern Ghana. Fifteen (15) patients who had been receiving HD for at least six (6) months were purposively selected and interviewed using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim, and analysed using Braun and Clarke's reflective thematic analysis. RESULTS: Two main themes were identified: respect for patient preferences and physical comfort, each with three sub-themes. Patients highlighted the importance of involvement in decision-making, maintaining dignity, respect for autonomy, and culturally sensitive care as essential components of quality nursing care. Perceptions of physical comfort were shaped by effective pain management, timely assistance with activities of daily living, and a clean hospital environment. CONCLUSION: Enhancing patient-centered care for individuals undergoing HD requires practical and context-appropriate interventions that address both interpersonal and system-level factors. Key strategies to improve quality nursing care include nurse-led patient education using simple local language, routine pain assessment, timely management during dialysis, preservation of patient privacy, compassionate communication, and culturally responsive care. Also, addressing workflow inefficiencies and strengthening dialysis centers with resources may further improve patients' treatment experiences, satisfaction, and overall quality of care in resource-constrained settings. Regular monitoring of discomfort, timely response to pains and cramps, ensuring privacy during procedures, and improving workflow to reduce waiting time were also emphasised. Continued staff education in compassionate communication (soft skills) and culturally sensitive care, and improved dialysis resources were recommended to address both interpersonal and structural barriers to quality care.