They Are Like Family: A Qualitative Thematic Analysis of Nurses’ Experiences in a Tshwane Dialysis Unit

Abstract

Highlights: What are the main findings? Dialysis nurses develop deep, family-like relationships with patients, which provide meaning but also expose them to emotional exhaustion, moral distress, and compassion fatigue. Persistent shortages of human and material resources along with limited managerial visibility and support significantly hinder nurses’ ability to deliver safe, compassionate, and holistic Chronic kidney disease care. What are the implications of the main findings? Strengthening leadership presence, emotional support systems, and nephrology-focused staff development is essential to sustaining nurse wellbeing and improving the consistency and quality of dialysis care. Addressing systemic gaps in staffing, equipment availability, and timely maintenance is critical for reducing moral distress, preventing avoidable patient harm, and advancing equitable CKD care aligned with Sustainable Development Goals 3. Background: Chronic kidney disease (CKD) continues to place immense strain on health systems globally, with nurses at the centre of care delivery physically, emotionally, and relationally. In dialysis units, nurses form long-term therapeutic relationships with patients who depend on life-sustaining treatment several times a week. Objective: This study explored the lived experiences of professional nurses caring for patients with CKD in a dialysis unit, using Watson’s Theory of Human Caring as a guiding framework. Methods: A qualitative, exploratory, descriptive design was employed. Data were collected through in-depth face-to-face interviews with twelve professional nurses and analyzed using thematic analysis. Trustworthiness was ensured through credibility, dependability, confirmability, transferability, and authenticity. Ethical approval and informed consent were obtained. Results: Three themes emerged: (1) emotional and professional experiences, (2) systemic resource constraints, and (3) recommendations for practice improvement. These findings highlight the tension between caring ideals and systemic limitations. Conclusions: The study concludes that dialysis nursing is profoundly meaningful yet emotionally demanding. Strengthened emotional support, improved leadership visibility, consistent resource allocation, and enhanced nephrology nursing education are critical to sustaining compassionate care. The findings offer important insights for policy, workforce development, and quality improvement efforts in CKD care.