Develoment of a guideline for professional nurses in Ghana to support self-management in patients with end-stage renal disease

Abstract

Background End-stage renal disease (ESRD) is an increasing public health concern in Ghana, where limited healthcare infrastructure, and high treatment costs often affecting patient outcomes. Supporting patients to manage their conditions is therefore essential. This study aimed to develop an evidence-based guideline to assist professional nurses in promoting self-management among patients living with ESRD.

Methods A multi-phase mixed-methods approach was used. Phase one employed a concurrent mixed-methods design in three teaching hospitals in Ghana. Qualitative data were collected through interviews with 30 patients diagnosed with ESRD to explore their experiences of living with the condition. Quantitative data were obtained from 425 nurses working in renal and dialysis units using the Self-Efficacy and Performance in Self-management Support survey. Phase two involved a scoping review conducted according to PRISMA-ScR guidelines to identify existing evidence on ESRD self-management support. In phase three, findings from the interviews, survey, and scoping review were integrated through methodological triangulation. A modified Delphi technique involving 15 experts across two rounds was used to develop and validate the guideline.

Results Patients described delayed diagnoses, challenges adjusting to strict dietary and treatment requirements, emotional distress, and significant financial barriers. Limited access to specialised services and inconsistent patient education further affected their ability to manage the disease. Family support and spirituality were important sources of coping. Survey findings showed moderate levels of self-efficacy and performance among nurses in supporting patient self-management. Significant differences were found across healthcare facilities and gender (p<0.05). Nurses reported strong confidence in providing disease information but less confidence in helping patients actively participate in their care, highlighting a gap between knowledge and practice. The scoping review identified key elements for effective ESRD self-management support, including structured patient education, cultural sensitivity, family involvement, and efficient use of limited resources. These findings informed the development of a guideline comprising eight domains, including patient assessment, education, psychosocial support, care coordination, and resource optimisation.

Conclusion This study provides a practical, evidence-based guideline to strengthen ESRD selfmanagement support in Ghana. Enhancing nursing education, implementing culturally appropriate patient education programmes, and improving care coordination are essential for supporting patients living with ESRD. The guideline offers a framework that may also be useful in other low- and middle-income countries facing similar challenges.