Understanding the factors influencing nurses in managing patients with diabetic ketoacidosis in the emergency departments of referral hospitals in Dar es Salaam, Tanzania: A descriptive qualitative study.

Abstract

The quality of nursing management of diabetic ketoacidosis (DKA) in emergency departments may be associated with either increased or decreased length of hospital stay. Despite that patient with DKA need intensive care unit (ICU) admission, effective initial nursing management of DKA patients at the emergency department is important. Regarding factors influencing the effective management when caring for patients with DKA, it is unknown how Tanzanian nurses perceive these issues. Therefore, this study was aimed to explore nurses' perceived factors influencing nursing management of DKA patients at emergency medical department (EMD) of two selected referral hospitals in Dar es Salaam, Tanzania. A descriptive qualitative study design was conducted to explore nurses' perspectives on the factors influencing nursing management of DKA patients. A total of twelve purposively selected nurses participated in in-depth interviews. The interview guide written in Kiswahili was used to collect data. All interviews were audio recorded and transcribed verbatim, and transcripts analyzed using qualitative content analysis. Two main themes emerged from the study including facilitators of DKA nursing management and barriers to DKA nursing management. Facilitators of DKA management encompassed three categories including nurses' knowledge of DKA, the availability of DKA management protocol, and nurses' skillset to enhance DKA management. On the other hand, barriers to DKA management had eight sub-categories including limited training on DKA management, lack of autonomy, decisions disagreement, delayed electrolyte results, scarcity of medical resources, shortage of nursing staffs, logistics in emergency care, and lack of specific-nursing management guideline. This study highlights facilitators and barriers to DKA management and underscores the need for comprehensive strategies to overcome these barriers and consolidate the facilitators to improve nurses' capacity in managing patients with DKA.