Perceived barriers to management of chronic kidney disease among nurses at two referal hospitals in Rwanda

Abstract

Background: The number of patients with chronic kidney disease (CKD) is gradually increasing in developed and developing countries including Rwanda, and this should be due to barriers like the lack of knowledge about the diagnosis and the management of CKD from the part of nurses, and other barriers related to patients such as lack of financial means, cultural lifestyles, negative attitude of patients. , In the low income countries, barriers to management of CKD have been associated with the health care settings like shortage of nephrologists, lack of trained nurses, lack of equipment and heavy workload.

Aim of the study: the aim of this study was to assess the barriers to management of CKD among nurses working at the referral hospitals in Rwanda. Methodology: this study used cross sectional research design with quantitative approach. The study settings were University teaching Hospital of Kigali (CHUK) and Rwanda Military Hospital (RMH). The sample was made of 55 nurses from internal medicine and haemodialysis unit. The data have been collected using a self-administered questionnaire and analysed using descriptive and inferential statistics in SPSS application.

Results: Findings from this study revealed that 21.8%, 25.5% and 20% of participants were respectively ignoring that hypertension; diabetes and HIV are risk factors for CKD. 78.2% recognized that the management of CKD is based on dietary restriction. Regarding the barriers based on training, 20% of participants have had a special training on CKD. The barriers related to workforce showed that there was a shortage of nephrologists (98%), shortage of nurses (87.3%), and lack of multidisciplinary team work (94.5%). Regarding the barriers related to caregivers, 81.8% of participants pointed out the lack of caregivers‟ awareness about CKD, 85% the use of herbal medicines among CKD patients, and 85.5% the lack of appropriate diet for CKD patients. Other revealed barriers were like financial issues (87.3%) and negative attitude of patients (70.9%). About the associations between demographic factors and perceived barriers to management of CKD, age of respondents was associated with the barriers to management of CKD: knowledge about hypertension as risk factor of CKD (p-value >0.001), and patients‟ negative attitude (p-value 0.027). Gender was also associated with the management of CKD based on medication (p-value 0.036). Other factors like occupation and training were not found to be associated with the outcome variable.

Conclusion: This study showed that there is still perceived barriers to CKD management among nurses, which has to be overtaken to better the management of CKD. But further studies are needed on the recognized gaps to identify possible solutions.