Exploring Nurses' Experiences and Challenges in Managing Diabetic Amputations: A Qualitative Study

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Nurses serve as frontline healthcare providers in managing these patients. Aim This qualitative study explores nurses' experiences and challenges in managing diabetic amputations at the Sunyani Teaching Hospital in Ghana. Methods Using a phenomenological approach, semi-structured interviews were conducted with 13 nurses working in the diabetic and surgical units of the Sunyani Teaching Hospital (STH) between April 2024 and July 2024. Results The study identified three key themes regarding nurses’ experiences in managing diabetic amputations: emotional and psychological challenges, physical and resource constraints, and recommendations for improvement. Findings indicate that nurses face emotional burdens, resource limitations, difficulties in patient–nurse relationships, and challenges in developing coping mechanisms while caring for patients with diabetes-related amputations. Conclusion The findings provide valuable insights into the challenges faced by nurses and suggest strategies for improving care delivery and outcomes for individuals with diabetic amputations. Recommendation To enhance patient outcomes, nurses recommend improved training, better resource allocation, and interdisciplinary collaboration. Additionally, there is a need for structured mental health support programs for nurses coping with emotionally taxing situations. Emphasis is also placed on incorporating specialized diabetic wound care training into the national nursing curriculum. Diabetic amputation nursing experiences healthcare challenges phenomenology qualitative study Figures Figure 1 Introduction Diabetes mellitus is a growing global health concern, including in Ghana, where diabetic amputation remains one of its severe complications [ 1 ]. Diabetes mellitus is a chronic metabolic disorder that has reached epidemic proportions worldwide, with devastating complications such as diabetic foot ulcers significantly contributing to morbidity and mortality [ 2 ]. Poorly managed diabetes often leads to chronic ulcers and infections, making amputation a necessary intervention in advanced cases [ 3 ]. Diabetic ulcers are a major cause of lower-limb amputations globally, particularly in low- and middle-income countries (LMICs), where healthcare systems are under-resourced [ 4 ]. Advanced healthcare infrastructure in high-income countries allows for the implementation of evidence-based wound care techniques, including negative pressure wound therapy and bioengineered skin substitutes, which improve healing outcomes and ease the work of nurses [ 5 ]. Additionally, multidisciplinary teams, often led by nurses, collaborate with physicians, podiatrists, and physiotherapists to optimize recovery and prevent further complications [ 6 ]. In Ghana, the prevalence of diabetes has been steadily increasing, exacerbated by late diagnosis, inadequate management, and limited access to specialized care [ 7 ]. Amputation resulting from diabetes remains a significant public health challenge, often leading to increased morbidity and mortality [ 6 ]. Nurses serve as frontline healthcare providers in managing these patients [ 8 ]. In resource-constrained settings like Ghana, the burden of diabetic amputations is intensified by inadequate healthcare infrastructure, limited resources, and workforce shortages, making the management of such cases particularly challenging for nurses [ 9 ]. Studies from LMICs have highlighted similar difficulties. For instance, in sub-Saharan Africa, nurses face inadequate training, a lack of essential medical supplies, and emotional burnout while managing diabetic complications [ 10 , 11 ]. A study in Uganda found that nurses struggled with heavy workloads and limited professional development opportunities, affecting their ability to provide optimal amputee care [ 8 ]. Similarly, research in Brazil revealed that resource shortages and a lack of structured care pathways hindered effective diabetes management in hospital settings [ 12 ]. These findings underscore the global nature of the issue, particularly in resource-limited healthcare environments. Despite these insights, little is known about the specific challenges faced by nurses in Ghana regarding diabetic amputee care. Existing studies in Ghana have primarily focused on the epidemiology of diabetes and its complications [ 13 ] or patient experiences with amputation [ 14 ], with minimal attention given to frontline nurses who provide direct care. This gap in the literature highlights the need for an in-depth qualitative exploration of nurses' experiences, including emotional, psychological, and logistical challenges, to inform evidence-based interventions. There is also limited research on nurses’ experiences and challenges in managing patients with diabetes-related amputations in Ghana. Existing studies have primarily examined clinical outcomes and patient experiences, leaving a gap in understanding the difficulties faced by nurses. Addressing this gap is essential for developing targeted interventions that enhance nurses' capacity to deliver holistic, patient-centered care. This study aims to explore nurses' experiences and challenges in managing diabetic individuals with amputations in Ghana, focusing on their lived experiences, challenges, and coping mechanisms. By shedding light on these aspects, the findings will inform policies and practices to improve nursing care and ultimately enhance outcomes for patients with diabetes-related amputations. Materials and methods Study setting The study was conducted at Sunyani Teaching Hospital, a 300-bed urban hospital located in the Bono Region of Ghana. It serves as a referral facility for the Middle Belt of Ghana and neighboring Côte d’Ivoire. The hospital comprises several units, including diabetic, orthopedic, physiotherapy, and psychiatry departments. It has over 700 nurses working in various capacities within the healthcare system. The hospital has a high incidence of patients admitted with diabetes-related amputations, which are managed by nurses. Study design and population Table 1 Demographic profile of participants Characteristics of Nurse participants (N = 13) Category Frequency(N) Gender Male 5 Female 8 Age 21–30 3 31–40 5 41–50 4 Above 50 1 Years of practice 1–5 2 5–10 2 11–20 6 21 and more 3 Level of education Diploma 7 Bachelors 5 Masters and above 1 Rank Staff nurse 2 Senior staff nurse 5 Nursing officer 3 Senior nursing officer 2 Principal nursing officer 1 Deputy Director of Nursing Service 0 An exploratory qualitative study was conducted to examine nurses' experiences and challenges in the care and treatment of patients who had undergone above-the-knee or hip amputations due to diabetes. Data collection took place from April 2024 to July 2024, following approval from the Committee for Human Research Publication and Ethics (Reference number: CHRE/AP/178/023) at the University of Energy and Natural Resources, as well as written permission from STH. Participants provided written informed consent before data collection, and their privacy and confidentiality were maintained throughout the study. The research adhered to strict ethical principles, including voluntary participation, anonymity, and confidentiality. Participants were explicitly informed of their right to withdraw from the study at any time without repercussions. The interview guide, reviewed by three qualitative research experts, was refined based on feedback from pilot testing to ensure its relevance to the research objectives. Participants were purposively selected based on their experience working in the orthopedic ward and caring for patients with diabetic amputations. Nurses who did not meet the inclusion criteria or declined participation were excluded. Recruitment continued until data saturation was reached with the tenth participant, with no new information emerging by the thirteenth interview. The interview guide consisted of three major questions and eight follow-up prompts and was rated as having moderate to strong content validity. Data collection involved face-to-face interviews conducted in English by the lead researcher in the nurses' offices at the orthopedic unit of STH. Each interview lasted between 30 and 60 minutes and was recorded using an audio recorder (DVT4110 VoiceTracer, Philips, Amsterdam, Netherlands), with supplemental field notes. A pretest involving three nurses with similar characteristics to the study population further refined the guide for clarity and relevance. The data collected from interviews with nurses managing diabetic amputations were analyzed using thematic analysis, guided by Braun and Clarke’s framework [ 15 ]. This process followed six key steps: (1) familiarization with the data through repeated reading, (2) generating initial codes, (3) searching for themes, (4) reviewing themes, (5) defining and naming themes, and (6) producing the final report. To ensure a systematic and rigorous approach, NVivo 14 software was used to facilitate coding and data organization. Initially, all interviews were transcribed verbatim and imported into NVivo, where open coding was performed. These codes were then grouped into broader categories, allowing for the identification of emerging patterns that contributed to the formation of preliminary themes. To enhance data credibility and reliability, the lead researcher transcribed the interviews, verified accuracy through repeated listening, and shared the transcripts with three qualitative research experts for validation. Trustworthiness of the study The interpreted themes were shared with selected participants to confirm their accuracy and relevance. Additionally, an independent researcher familiar with qualitative analysis reviewed the coding process to ensure consistency and minimize bias. Any discrepancies that arose during the analysis were resolved through discussion among the research team, ensuring consensus and analytical rigor. A reflexive journal was maintained throughout the analysis to document researcher perspectives and potential biases, ensuring transparency. Furthermore, thematic saturation was considered when no new codes or themes emerged from additional interviews. By detailing the analytical process, including software use and validation strategies, we provide a transparent and rigorous account of how themes were derived, ensuring the reliability and credibility of our study. The analysis resulted in 10 categories grouped into three main themes (Table 2), reflecting nurses' experiences in managing patients with diabetic amputations and their efforts to meet patients' needs in clinical practice. Results The study identified three major themes and ten subthemes related to nurses’ experiences and challenges in managing diabetic individuals with amputations. These themes included: (1) emotional and psychological challenges, (2) physical and resource constraints, and (3) recommendations for improvement. To confirm the accuracy of the qualitative findings, a literature review on the topic was conducted, and the data were analyzed. As a result, the results and discussion were combined, with relevant quotes and supporting research used to substantiate the findings. Emotional and psychological challenges 1.1. Nurses Experienced Feelings of Empathy, Helplessness, and Frustration Nurses reported significant emotional challenges in providing care to patients with amputations, including feelings of empathy, helplessness, and frustration. This may stem from the fact that Ghanaian society places great value on communal living and compassion, leading many nurses to naturally empathize with their patients' struggles and suffering. Additionally, nurses often spend significant time with patients, building rapport and emotional bonds, which makes them more sensitive to their patients' pain and challenges. This is reflected in the statement: "I become so helpless at times when giving care to these patients; I see myself in their worries, concerns, and pains, and this sometimes makes me break down." (N3) "For how long will they (patients) continue with this sudden change in their self-image, role, and pain? Patients often place excessive confidence in me, expecting miraculous solutions to their critical conditions. However, I feel inadequate when I cannot fully meet their expectations." (N5) 1.2. Nurses Expressed the Need for Institutional Mechanisms to Support Their Well-Being Participants indicated that they often manage their emotional burden by relying on peer support and personal faith but expressed the need for institutional mechanisms to support their emotional well-being. This sentiment is captured in the following statements: "Caring for these patients often leaves me feeling down. At times, I feel the hospital should come to our aid to help us overcome this emotional trauma, as I feel my husband's support doesn’t always suffice." (N1) "Sometimes I get home from the hospital struggling to pull myself together. I even struggle to sleep, with these patients on my mind. Most times, I try to pray to overcome this, but to no avail. I know I need counseling myself, and the hospital must help." (N10) 1.3. Nurses Revealed Difficulties in Building Relationships with Patients to Foster Trust and Encourage Adherence to Treatment Nurses emphasized the importance of building strong relationships with patients but acknowledged that they often face difficulties in fostering trust. Many healthcare facilities in Ghana lack essential resources, such as medications, equipment, and infrastructure, making it challenging for nurses to provide the necessary care. Additionally, high nurse-to-patient ratios and long working hours leave nurses overwhelmed and unable to provide adequate attention to each patient. This challenge is reflected in the following statements: "When I am unable to meet their heightened expectations, some patients see me as incapable of helping them and, as a result, tend to lose trust in us. Can you imagine a patient retorting, 'What help can you possibly give in my situation? I don’t even see the difference between being here and at home?'" (N7) "It sometimes takes extra effort to convince a patient to take medication after an amputation, as they often express doubts, saying, 'If the drug could have helped, then why the amputation in the first place?' For some of these patients, it is a herculean task." (N6) 2.0. Physical and Resource Challenges 2.1. Wound and Rehabilitation Care Nurses stressed the need for aseptic management of diabetic stumps after amputation to prevent complications. They emphasized that the rehabilitation process should start preoperatively and continue postoperatively, requiring strong commitment from healthcare providers. "After an amputation, the surgical wound requires dedicated care to heal properly with minimal scarring and complications, and this truly takes time. One needs a combined effort from the healthcare team to ensure this." (N9) "The rehabilitation process is challenging, as some patients lack cooperation. It is truly demanding when significant effort is required to get the patient involved." (N4) 2.2. Nurses Faced Challenges in Pain and Comfort Management Almost all the nurses reported difficulties in managing the pain experienced by patients with diabetes-related amputations. They emphasized that ensuring patient comfort is a challenge due to frequent shortages of essential pain medications, including opioids and non-opioid analgesics, in many healthcare facilities in Ghana. Additionally, many patients with diabetic neuropathy experience a loss of sensation, yet they suffer from intense and persistent pain caused by infections or ischemia, which affects their ability to sleep. "Most patients are unable to sleep at night because excruciating pain is aggravated by ischemic-related events. This puts a heavy burden on the few of us on duty, as we work tirelessly to provide some level of comfort." (N8) "Helping these patients attend to nature's call is sometimes hectic, especially for those who are stout and often soil themselves in bed. Additional effort and constant care are needed to prevent pressure ulcers." (N11) 2.3. Nurses Lacked Adequate Resources to Provide Optimal Care Participants highlighted a lack of adequate resources, including wound care materials, prosthetics, and orthotic devices. This shortage often compromised the quality of care provided. "When it comes to the availability of resources, the less said, the better. We lack everything, from wound care materials to prosthetic and orthotic devices, making the commencement of rehabilitation a challenge." (N12) "It's all about improvising and patients acquiring their own materials for wound care, which is often difficult for us nurses. Sometimes, the stench during debridement and dressing in the ward is discomforting, but as nurses, we must endure it along with the other patients." (N13) 2.4. Heavy Workload and Responsibilities Nurses reported that heavy workloads left them feeling that they did not spend enough time with patients and their families. Overcrowding in hospitals and understaffing meant they had little opportunity to provide individualized care, making patient-centered management difficult. "We often spend less time with our patients and their families than we would like, simply because we are unable to attend to all the patients under our care. The patients truly need us more to express their deeper feelings, and I find this inadequate." (N1) "I wish we had more time to talk with our patients and truly understand their struggles and challenges, but this seems impossible since we have to attend to them all." (N2) 3.0. Recommendations for Improvement 3.1. Nurses Called for Regular In-Service Training Nurses emphasized the need for regular in-service training, particularly regarding the care of individuals with diabetes and diabetes-related complications. They stressed that focused and specialized training is essential to improving patient care. "There is a need for us to constantly update our knowledge and skills in patient care. The care of patients with special needs is constantly evolving, and without conscious efforts, our nursing skills will always fall short." (N3) "I would say that before being assigned to this ward, one should first undergo training to acquire specialized skills, as caring for these patients differs from mainstream nursing." (N7) 3.2. Nurses Called for Better Resource Acquisition and Allocation Nurses suggested better resource allocation to enhance patient care. "The equipment we work with is mostly either obsolete or faulty. Management needs to acquire up-to-date equipment to provide the best nursing care to these patients." (N5) "Basic materials for wound care, as well as prosthetic and orthotic devices, seem to be nonexistent. Sometimes, I feel that management doesn’t truly care, and this makes it difficult for us to provide proper care for these patients." (N4) 3.3. Integration and Commitment of the Healthcare Team Nurses suggested integrating multidisciplinary teams, including psychologists, dietitians, diabetologists, and social workers, to enhance patient care. "To enhance the care of individuals with diabetic amputations, we need all members of the healthcare team to be fully committed to patient care." (N6) Discussion This study underscores the complex interplay of emotional, resource-related, and systemic factors affecting nurses' ability to care for patients with diabetes-related amputations. The key themes identified include emotional and psychological challenges, resource constraints, systemic inadequacies, and recommendations for improvement. These findings were analyzed in comparison with existing literature to provide a comprehensive understanding of the challenges faced by nurses in both developed and developing countries. Nurses frequently experience empathy, helplessness, and frustration when caring for diabetic patients with amputations. Many nurses express deep emotional involvement, often internalizing patient suffering, a phenomenon commonly observed in low-resource settings [ 16 ]. In Ghana, where communal living and compassion are highly valued, nurses tend to form strong emotional bonds with their patients. However, heightened patient expectations exacerbate emotional distress, as nurses feel inadequate when unable to meet these expectations. Similar findings were reported by [ 17 ], who noted that unrealistic patient expectations contribute to the psychological burden on nurses in low- and middle-income countries. In contrast, nurses in developed countries also experience emotional distress; however, structured interventions such as counseling services, peer support groups, and employee assistance programs (EAPs) help mitigate these challenges [ 18 ]. For example, the National Health Service (NHS) in the UK provides mental health and well-being support for nurses to reduce burnout and emotional exhaustion [ 19 ]. This structured support is largely absent in many developing countries, where nurses often lack institutional mechanisms to address emotional trauma. Establishing counseling units in public hospitals could provide crucial psychological support, as recommended by [ 20 ], who emphasized the need for structured mental health interventions to mitigate caregiver burnout. A major challenge identified was the difficulty in building trust with patients. Many nurses struggle to manage patient expectations, leading to strained nurse-patient relationships. This aligns with the findings of [ 21 ], who highlighted that unmet expectations in chronic care settings often undermine trust. In developed countries, patient trust in healthcare professionals is often reinforced by clear communication strategies and structured patient education programs [ 22 ]. Nurses receive specialized training in breaking bad news, managing expectations, and fostering therapeutic relationships, which enhances patient compliance and satisfaction [ 23 ]. However, in developing countries, nurses often lack such training, contributing to patient dissatisfaction and diminished trust in healthcare providers. Addressing these trust issues requires targeted training in effective communication strategies, patient education, and cultural competence. Incorporating these elements into nursing education could improve interactions between nurses and patients, ultimately enhancing treatment adherence. The management of diabetic stumps and the rehabilitation process are resource-intensive and demanding. Participants reported that proper wound care is essential for healing, a finding supported by [ 24 ], who emphasized the need for multidisciplinary collaboration in rehabilitation. Pain management emerged as a significant hurdle, with nurses describing patients’ struggles with excruciating pain due to ischemia and infection. Some nurses noted that patients were often unable to sleep at night due to severe pain, a challenge echoed by [ 25 ], who identified inadequate pain relief options in low-resource settings as a critical issue in diabetic care. Developed countries typically have access to advanced wound care technologies, prosthetic devices, and pain management options such as nerve blocks and specialized analgesics [ 26 ]. Conversely, nurses in developing countries frequently encounter shortages of essential medical supplies, including wound care materials, prosthetics, and orthotic devices. They often resort to improvisation due to these shortages, a situation mirrored in [ 27 ], which found that resource limitations in sub-Saharan Africa compromise healthcare quality. Addressing these gaps requires strategic policy interventions at institutional and governmental levels, prioritizing improved resource allocation, procurement of essential supplies, and increased funding for diabetic care programs. Participants strongly advocated for continuous professional development to enhance their knowledge and skills. This aligns with [ 28 ], who emphasized the role of in-service training in improving nursing care for patients with complex needs. Integrating specialized courses on diabetic wound care and rehabilitation into nursing education, alongside hands-on simulation-based training, could bridge existing knowledge gaps in amputation management. In developed countries, continuous professional development is often mandatory, with nurses required to update their skills through workshops, certification programs, and clinical training [ 29 ]. These structured training programs ensure that nurses are equipped with the latest knowledge and best practices in diabetic care. However, in many developing countries, access to such training is limited due to financial constraints and a lack of institutional support [ 30 ]. Governments and healthcare institutions should invest in continuous education programs to ensure nurses receive ongoing training in diabetic wound care, pain management, and rehabilitation. In addition to training, nurses emphasized the need for better resource availability and the integration of multidisciplinary teams to improve patient care. They stressed that a collaborative approach involving nurses, physicians, psychologists, dietitians, and social workers would lead to more effective management of diabetic amputations. This finding resonates with [ 31 ], who highlighted the importance of team-based approaches in managing chronic conditions. Multidisciplinary collaboration is well established in developed healthcare systems, where care pathways involve coordinated input from various healthcare professionals [ 32 ]. However, in developing countries, a lack of structured teamwork and communication between health professionals often results in fragmented care. Structured care pathways that foster teamwork among healthcare professionals should be implemented to ensure a holistic approach to diabetic care. Limitations This study was conducted at a public hospital, which may differ in organizational structure and resources compared to private or rural hospitals. This context may influence the applicability of findings to other settings providing care to patients with diabetic amputations. The participants included general nurses from various surgical units, which may mean their knowledge and experiences are broad but not necessarily specific to the care of patients with diabetic amputations. The qualitative approach relies on subjective accounts, which may reflect individual experiences rather than universally applicable patterns. Additionally, the small and relatively homogenous sample size could limit the range of perspectives represented. The cultural and systemic context in Ghana likely shaped the findings, which may require careful consideration or adaptation when applied to different sociocultural and healthcare environments. Finally, resource constraints during the study may have restricted the depth of exploration into some aspects of care and challenges faced by nurses. Future research could address these limitations by conducting comparative studies across multiple healthcare settings, including private and rural hospitals, to explore variations in organizational structure, resources, and patient outcomes. Incorporating a mixed-methods approach with both qualitative and quantitative data could enhance the reliability of findings, balancing subjective experiences with measurable trends. Additionally, longitudinal studies could capture evolving trends in nursing care, resource availability, and systemic influences over time, offering a more nuanced and transferable understanding of the findings. Conclusion Implementing structured mental health support programs for nurses facing emotionally taxing situations is essential for their well-being and professional effectiveness. Additionally, advocating for the inclusion of specialized diabetic wound care training in national nursing curricula can enhance patient outcomes and reduce diabetes-related complications. Prioritizing these initiatives will not only support nurses in their demanding roles but also improve overall healthcare quality. Implications for Practice and Education There is a need to establish national guidelines to standardize diabetic foot care and amputation management, ensuring consistency in treatment and resource availability. Additionally, integrating mental health education into nursing curricula can equip nurses with coping strategies for the emotional challenges associated with chronic patient care. By addressing these implications, healthcare facilities can create an enabling environment for nurses to deliver quality care, thus improving patient outcomes and overall healthcare delivery in Ghana and similar settings. Declarations Ethics approval and consent to participate The research was conducted in accordance with the Declaration of Helsinki. Data collection was done after obtaining approval from the Committee for Human Research Publication and Ethics (Ref: CHRE/AP/178/023) of the University of Energy and Natural Resources and a written permit from the Sunyani Teaching Hospital. An informed consent was obtained from all participants Consent for publication Not applicable Clinical trial number Not applicable Availability of data and materials Not applicable (this manuscript does not report data generation or analysis) Competing interests The authors declare that they have no competing interests Funding The research had no funding. All cost was borne by the authors. Authors' contributions BEA: Conceptualization, original draft, investigation, data collection, analysis, AH: Conceptualization, analysis, validation, writing critical review and editing CAA: Data collection, validation, review of the manuscript TP: Validation, review and editing of the manuscript RB: Data collection, validation, manuscript review and editing Acknowledgements Not applicable Authors' information 1 Department of Nursing, School of Sciences, University of Energy and Natural Resources, Sunyani, Ghana 2 Nursing, Holy Family Nursing and Midwifery Training College, Berekum, Ghana References Boateng D, Ayellah BB, Adjei DN, Agyemang C. Contribution of diabetes to amputations in sub-Sahara Africa: A systematic review and meta-analysis. Prim Care Diabetes. 2022;16(3):341–9. https://doi.org/10.1016/j.pcd.2022.01.011 . Arokiasamy P, Salvi S, Selvamani Y. Global burden of diabetes mellitus. Handbook of Global Health. 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Diabetic foot workshop: Improving technical and educational skills for nurses. Med J Islamic Repub Iran. 2017;31:8. Zickafoose A, Ilesanmi O, Diaz-Manrique M, Adeyemi AE, Walumbe B, Strong R, Wingenbach G, Rodriguez MT, Dooley K. Barriers and challenges affecting quality education (Sustainable Development Goal# 4) in sub-Saharan Africa by 2030. Sustainability. 2024;16(7):2657. https://doi.org/10.3390/su16072657 . Tandan M, Dunlea S, Cullen W, Bury G. Teamwork and its impact on chronic disease clinical outcomes in primary care: a systematic review and meta-analysis. Public Health. 2024;229:88–115. 10.1016/j.puhe.2024.01.019 . Epub 2024 Feb 26. PMID: 38412699. DOI: 10.1016/j.puhe.2024.01.019. Additional Declarations No competing interests reported. Supplementary Files InterviewguideBMC.pdf Cite Share Download PDF Status: Published Journal Publication published 08 May, 2025 Read the published version in BMC Nursing → Version 1 posted Editorial decision: Revision requested 25 Mar, 2025 Reviews received at journal 24 Mar, 2025 Reviewers agreed at journal 24 Mar, 2025 Reviewers invited by journal 24 Mar, 2025 Submission checks completed at journal 22 Mar, 2025 First submitted to journal 20 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5891005","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":433975785,"identity":"9d421555-481a-4b02-a875-ffdfab647736","order_by":0,"name":"Ba-Etilayoo Atinga","email":"data:image/png;base64,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","orcid":"","institution":"University of Energy and Natural Resources","correspondingAuthor":true,"prefix":"","firstName":"Ba-Etilayoo","middleName":"","lastName":"Atinga","suffix":""},{"id":433975786,"identity":"4ec6ed0c-558f-4b06-b596-abe1b1d42293","order_by":1,"name":"Albert Henyo","email":"","orcid":"","institution":"University of Energy and Natural Resources","correspondingAuthor":false,"prefix":"","firstName":"Albert","middleName":"","lastName":"Henyo","suffix":""},{"id":433975790,"identity":"c8f7390c-9f7c-4fb3-a624-82b77c5853e7","order_by":2,"name":"Christiana Asospae Ayamga","email":"","orcid":"","institution":"University of Energy and Natural Resources","correspondingAuthor":false,"prefix":"","firstName":"Christiana","middleName":"Asospae","lastName":"Ayamga","suffix":""},{"id":433975792,"identity":"ee7fbe21-6c6f-43b3-9f89-6e5c8d14642c","order_by":3,"name":"Tulukuu Perekuu","email":"","orcid":"","institution":"Holy Family Nursing and Midwifery Training College","correspondingAuthor":false,"prefix":"","firstName":"Tulukuu","middleName":"","lastName":"Perekuu","suffix":""},{"id":433975795,"identity":"ab290955-91b4-4660-ae78-278800bd4d76","order_by":4,"name":"Rosemary Braimah","email":"","orcid":"","institution":"University of Energy and Natural Resources","correspondingAuthor":false,"prefix":"","firstName":"Rosemary","middleName":"","lastName":"Braimah","suffix":""}],"badges":[],"createdAt":"2025-01-23 21:08:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5891005/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5891005/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12912-025-03143-4","type":"published","date":"2025-05-08T15:57:19+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":79319542,"identity":"76c18bde-4f63-4330-b0f0-1cffe1f4f879","added_by":"auto","created_at":"2025-03-27 04:17:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":90594,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSummary of Emerged Themes and Subthemes\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5891005/v1/98b5de0049a3f6af81e5294b.png"},{"id":82537671,"identity":"00504c7c-14ed-4c5e-9a64-dede2dc59feb","added_by":"auto","created_at":"2025-05-12 16:09:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":843693,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5891005/v1/986c5fce-a7f5-4158-b5d4-1b5e853198c4.pdf"},{"id":79320880,"identity":"9a05c103-dea9-4ff8-b4d1-d9db12d8dc39","added_by":"auto","created_at":"2025-03-27 04:25:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":83619,"visible":true,"origin":"","legend":"","description":"","filename":"InterviewguideBMC.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5891005/v1/259851adc86905d128c44ef4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring Nurses' Experiences and Challenges in Managing Diabetic Amputations: A Qualitative Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDiabetes mellitus is a growing global health concern, including in Ghana, where diabetic amputation remains one of its severe complications [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Diabetes mellitus is a chronic metabolic disorder that has reached epidemic proportions worldwide, with devastating complications such as diabetic foot ulcers significantly contributing to morbidity and mortality [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Poorly managed diabetes often leads to chronic ulcers and infections, making amputation a necessary intervention in advanced cases [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Diabetic ulcers are a major cause of lower-limb amputations globally, particularly in low- and middle-income countries (LMICs), where healthcare systems are under-resourced [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Advanced healthcare infrastructure in high-income countries allows for the implementation of evidence-based wound care techniques, including negative pressure wound therapy and bioengineered skin substitutes, which improve healing outcomes and ease the work of nurses [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Additionally, multidisciplinary teams, often led by nurses, collaborate with physicians, podiatrists, and physiotherapists to optimize recovery and prevent further complications [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Ghana, the prevalence of diabetes has been steadily increasing, exacerbated by late diagnosis, inadequate management, and limited access to specialized care [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Amputation resulting from diabetes remains a significant public health challenge, often leading to increased morbidity and mortality [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Nurses serve as frontline healthcare providers in managing these patients [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn resource-constrained settings like Ghana, the burden of diabetic amputations is intensified by inadequate healthcare infrastructure, limited resources, and workforce shortages, making the management of such cases particularly challenging for nurses [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Studies from LMICs have highlighted similar difficulties. For instance, in sub-Saharan Africa, nurses face inadequate training, a lack of essential medical supplies, and emotional burnout while managing diabetic complications [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. A study in Uganda found that nurses struggled with heavy workloads and limited professional development opportunities, affecting their ability to provide optimal amputee care [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Similarly, research in Brazil revealed that resource shortages and a lack of structured care pathways hindered effective diabetes management in hospital settings [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. These findings underscore the global nature of the issue, particularly in resource-limited healthcare environments.\u003c/p\u003e \u003cp\u003eDespite these insights, little is known about the specific challenges faced by nurses in Ghana regarding diabetic amputee care. Existing studies in Ghana have primarily focused on the epidemiology of diabetes and its complications [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] or patient experiences with amputation [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], with minimal attention given to frontline nurses who provide direct care. This gap in the literature highlights the need for an in-depth qualitative exploration of nurses' experiences, including emotional, psychological, and logistical challenges, to inform evidence-based interventions.\u003c/p\u003e \u003cp\u003eThere is also limited research on nurses\u0026rsquo; experiences and challenges in managing patients with diabetes-related amputations in Ghana. Existing studies have primarily examined clinical outcomes and patient experiences, leaving a gap in understanding the difficulties faced by nurses. Addressing this gap is essential for developing targeted interventions that enhance nurses' capacity to deliver holistic, patient-centered care.\u003c/p\u003e \u003cp\u003eThis study aims to explore nurses' experiences and challenges in managing diabetic individuals with amputations in Ghana, focusing on their lived experiences, challenges, and coping mechanisms. By shedding light on these aspects, the findings will inform policies and practices to improve nursing care and ultimately enhance outcomes for patients with diabetes-related amputations.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy setting\u003c/h2\u003e \u003cp\u003eThe study was conducted at Sunyani Teaching Hospital, a 300-bed urban hospital located in the Bono Region of Ghana. It serves as a referral facility for the Middle Belt of Ghana and neighboring C\u0026ocirc;te d\u0026rsquo;Ivoire. The hospital comprises several units, including diabetic, orthopedic, physiotherapy, and psychiatry departments. It has over 700 nurses working in various capacities within the healthcare system. The hospital has a high incidence of patients admitted with diabetes-related amputations, which are managed by nurses.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy design and population\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic profile of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics of Nurse participants (N\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency(N)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbove 50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eYears of practice\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 and more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eLevel of education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMasters and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eRank\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStaff nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSenior staff nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNursing officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSenior nursing officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrincipal nursing officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDeputy Director of Nursing Service\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAn exploratory qualitative study was conducted to examine nurses' experiences and challenges in the care and treatment of patients who had undergone above-the-knee or hip amputations due to diabetes. Data collection took place from April 2024 to July 2024, following approval from the Committee for Human Research Publication and Ethics (Reference number: CHRE/AP/178/023) at the University of Energy and Natural Resources, as well as written permission from STH. Participants provided written informed consent before data collection, and their privacy and confidentiality were maintained throughout the study. The research adhered to strict ethical principles, including voluntary participation, anonymity, and confidentiality. Participants were explicitly informed of their right to withdraw from the study at any time without repercussions.\u003c/p\u003e \u003cp\u003eThe interview guide, reviewed by three qualitative research experts, was refined based on feedback from pilot testing to ensure its relevance to the research objectives. Participants were purposively selected based on their experience working in the orthopedic ward and caring for patients with diabetic amputations. Nurses who did not meet the inclusion criteria or declined participation were excluded. Recruitment continued until data saturation was reached with the tenth participant, with no new information emerging by the thirteenth interview.\u003c/p\u003e \u003cp\u003eThe interview guide consisted of three major questions and eight follow-up prompts and was rated as having moderate to strong content validity. Data collection involved face-to-face interviews conducted in English by the lead researcher in the nurses' offices at the orthopedic unit of STH. Each interview lasted between 30 and 60 minutes and was recorded using an audio recorder (DVT4110 VoiceTracer, Philips, Amsterdam, Netherlands), with supplemental field notes. A pretest involving three nurses with similar characteristics to the study population further refined the guide for clarity and relevance.\u003c/p\u003e \u003cp\u003eThe data collected from interviews with nurses managing diabetic amputations were analyzed using thematic analysis, guided by Braun and Clarke\u0026rsquo;s framework [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This process followed six key steps: (1) familiarization with the data through repeated reading, (2) generating initial codes, (3) searching for themes, (4) reviewing themes, (5) defining and naming themes, and (6) producing the final report. To ensure a systematic and rigorous approach, NVivo 14 software was used to facilitate coding and data organization.\u003c/p\u003e \u003cp\u003eInitially, all interviews were transcribed verbatim and imported into NVivo, where open coding was performed. These codes were then grouped into broader categories, allowing for the identification of emerging patterns that contributed to the formation of preliminary themes. To enhance data credibility and reliability, the lead researcher transcribed the interviews, verified accuracy through repeated listening, and shared the transcripts with three qualitative research experts for validation.\u003c/p\u003e\n\u003ch3\u003eTrustworthiness of the study\u003c/h3\u003e\n\u003cp\u003eThe interpreted themes were shared with selected participants to confirm their accuracy and relevance. Additionally, an independent researcher familiar with qualitative analysis reviewed the coding process to ensure consistency and minimize bias. Any discrepancies that arose during the analysis were resolved through discussion among the research team, ensuring consensus and analytical rigor. A reflexive journal was maintained throughout the analysis to document researcher perspectives and potential biases, ensuring transparency. Furthermore, thematic saturation was considered when no new codes or themes emerged from additional interviews.\u003c/p\u003e \u003cp\u003eBy detailing the analytical process, including software use and validation strategies, we provide a transparent and rigorous account of how themes were derived, ensuring the reliability and credibility of our study. The analysis resulted in 10 categories grouped into three main themes (Table\u0026nbsp;2), reflecting nurses' experiences in managing patients with diabetic amputations and their efforts to meet patients' needs in clinical practice.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study identified three major themes and ten subthemes related to nurses\u0026rsquo; experiences and challenges in managing diabetic individuals with amputations. These themes included: (1) emotional and psychological challenges, (2) physical and resource constraints, and (3) recommendations for improvement. To confirm the accuracy of the qualitative findings, a literature review on the topic was conducted, and the data were analyzed. As a result, the results and discussion were combined, with relevant quotes and supporting research used to substantiate the findings.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eEmotional and psychological challenges\u003c/h3\u003e\n\u003cp\u003e \u003cb\u003e1.1.\u003c/b\u003e \u003cem\u003eNurses Experienced Feelings of Empathy, Helplessness, and Frustration\u003c/em\u003e\u003c/p\u003e \u003cp\u003eNurses reported significant emotional challenges in providing care to patients with amputations, including feelings of empathy, helplessness, and frustration. This may stem from the fact that Ghanaian society places great value on communal living and compassion, leading many nurses to naturally empathize with their patients' struggles and suffering. Additionally, nurses often spend significant time with patients, building rapport and emotional bonds, which makes them more sensitive to their patients' pain and challenges. This is reflected in the statement:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I become so helpless at times when giving care to these patients; I see myself in their worries, concerns, and pains, and this sometimes makes me break down.\"\u003c/em\u003e (N3)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"For how long will they (patients) continue with this sudden change in their self-image, role, and pain? Patients often place excessive confidence in me, expecting miraculous solutions to their critical conditions. However, I feel inadequate when I cannot fully meet their expectations.\"\u003c/em\u003e (N5)\u003c/p\u003e \u003cp\u003e \u003cb\u003e1.2.\u003c/b\u003e \u003cem\u003eNurses Expressed the Need for Institutional Mechanisms to Support Their Well-Being\u003c/em\u003e\u003c/p\u003e \u003cp\u003eParticipants indicated that they often manage their emotional burden by relying on peer support and personal faith but expressed the need for institutional mechanisms to support their emotional well-being. This sentiment is captured in the following statements:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Caring for these patients often leaves me feeling down. At times, I feel the hospital should come to our aid to help us overcome this emotional trauma, as I feel my husband's support doesn\u0026rsquo;t always suffice.\"\u003c/em\u003e (N1)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Sometimes I get home from the hospital struggling to pull myself together. I even struggle to sleep, with these patients on my mind. Most times, I try to pray to overcome this, but to no avail. I know I need counseling myself, and the hospital must help.\"\u003c/em\u003e (N10)\u003c/p\u003e \u003cp\u003e \u003cb\u003e1.3.\u003c/b\u003e \u003cem\u003eNurses Revealed Difficulties in Building Relationships with Patients to Foster Trust and Encourage Adherence to Treatment\u003c/em\u003e\u003c/p\u003e \u003cp\u003eNurses emphasized the importance of building strong relationships with patients but acknowledged that they often face difficulties in fostering trust. Many healthcare facilities in Ghana lack essential resources, such as medications, equipment, and infrastructure, making it challenging for nurses to provide the necessary care.\u003c/p\u003e \u003cp\u003eAdditionally, high nurse-to-patient ratios and long working hours leave nurses overwhelmed and unable to provide adequate attention to each patient. This challenge is reflected in the following statements:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"When I am unable to meet their heightened expectations, some patients see me as incapable of helping them and, as a result, tend to lose trust in us. Can you imagine a patient retorting, 'What help can you possibly give in my situation? I don\u0026rsquo;t even see the difference between being here and at home?'\"\u003c/em\u003e (N7)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"It sometimes takes extra effort to convince a patient to take medication after an amputation, as they often express doubts, saying, 'If the drug could have helped, then why the amputation in the first place?' For some of these patients, it is a herculean task.\"\u003c/em\u003e (N6)\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.0. Physical and Resource Challenges\u003c/h2\u003e \u003cp\u003e \u003cb\u003e2.1.\u003c/b\u003e \u003cem\u003eWound and Rehabilitation Care\u003c/em\u003e\u003c/p\u003e \u003cp\u003eNurses stressed the need for aseptic management of diabetic stumps after amputation to prevent complications. They emphasized that the rehabilitation process should start preoperatively and continue postoperatively, requiring strong commitment from healthcare providers.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"After an amputation, the surgical wound requires dedicated care to heal properly with minimal scarring and complications, and this truly takes time. One needs a combined effort from the healthcare team to ensure this.\"\u003c/em\u003e (N9)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"The rehabilitation process is challenging, as some patients lack cooperation. It is truly demanding when significant effort is required to get the patient involved.\"\u003c/em\u003e (N4)\u003c/p\u003e \u003cp\u003e \u003cb\u003e2.2.\u003c/b\u003e \u003cem\u003eNurses Faced Challenges in Pain and Comfort Management\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAlmost all the nurses reported difficulties in managing the pain experienced by patients with diabetes-related amputations. They emphasized that ensuring patient comfort is a challenge due to frequent shortages of essential pain medications, including opioids and non-opioid analgesics, in many healthcare facilities in Ghana.\u003c/p\u003e \u003cp\u003eAdditionally, many patients with diabetic neuropathy experience a loss of sensation, yet they suffer from intense and persistent pain caused by infections or ischemia, which affects their ability to sleep.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Most patients are unable to sleep at night because excruciating pain is aggravated by ischemic-related events. This puts a heavy burden on the few of us on duty, as we work tirelessly to provide some level of comfort.\"\u003c/em\u003e (N8)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Helping these patients attend to nature's call is sometimes hectic, especially for those who are stout and often soil themselves in bed. Additional effort and constant care are needed to prevent pressure ulcers.\"\u003c/em\u003e (N11)\u003c/p\u003e \u003cp\u003e \u003cb\u003e2.3.\u003c/b\u003e \u003cem\u003eNurses Lacked Adequate Resources to Provide Optimal Care\u003c/em\u003e\u003c/p\u003e \u003cp\u003eParticipants highlighted a lack of adequate resources, including wound care materials, prosthetics, and orthotic devices. This shortage often compromised the quality of care provided.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"When it comes to the availability of resources, the less said, the better. We lack everything, from wound care materials to prosthetic and orthotic devices, making the commencement of rehabilitation a challenge.\"\u003c/em\u003e (N12)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"It's all about improvising and patients acquiring their own materials for wound care, which is often difficult for us nurses. Sometimes, the stench during debridement and dressing in the ward is discomforting, but as nurses, we must endure it along with the other patients.\"\u003c/em\u003e (N13)\u003c/p\u003e \u003cp\u003e \u003cb\u003e2.4.\u003c/b\u003e \u003cem\u003eHeavy Workload and Responsibilities\u003c/em\u003e\u003c/p\u003e \u003cp\u003eNurses reported that heavy workloads left them feeling that they did not spend enough time with patients and their families. Overcrowding in hospitals and understaffing meant they had little opportunity to provide individualized care, making patient-centered management difficult.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"We often spend less time with our patients and their families than we would like, simply because we are unable to attend to all the patients under our care. The patients truly need us more to express their deeper feelings, and I find this inadequate.\"\u003c/em\u003e (N1)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I wish we had more time to talk with our patients and truly understand their struggles and challenges, but this seems impossible since we have to attend to them all.\"\u003c/em\u003e (N2)\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e3.0. Recommendations for Improvement\u003c/h3\u003e\n\u003cp\u003e \u003cb\u003e3.1.\u003c/b\u003e \u003cem\u003eNurses Called for Regular In-Service Training\u003c/em\u003e\u003c/p\u003e \u003cp\u003eNurses emphasized the need for regular in-service training, particularly regarding the care of individuals with diabetes and diabetes-related complications. They stressed that focused and specialized training is essential to improving patient care.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"There is a need for us to constantly update our knowledge and skills in patient care. The care of patients with special needs is constantly evolving, and without conscious efforts, our nursing skills will always fall short.\" (N3)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I would say that before being assigned to this ward, one should first undergo training to acquire specialized skills, as caring for these patients differs from mainstream nursing.\"\u003c/em\u003e (N7)\u003c/p\u003e \u003cp\u003e \u003cb\u003e3.2.\u003c/b\u003e \u003cem\u003eNurses Called for Better Resource Acquisition and Allocation\u003c/em\u003e\u003c/p\u003e \u003cp\u003eNurses suggested better resource allocation to enhance patient care.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"The equipment we work with is mostly either obsolete or faulty. Management needs to acquire up-to-date equipment to provide the best nursing care to these patients.\"\u003c/em\u003e (N5)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Basic materials for wound care, as well as prosthetic and orthotic devices, seem to be nonexistent. Sometimes, I feel that management doesn\u0026rsquo;t truly care, and this makes it difficult for us to provide proper care for these patients.\"\u003c/em\u003e (N4)\u003c/p\u003e \u003cp\u003e \u003cb\u003e3.3.\u003c/b\u003e \u003cem\u003eIntegration and Commitment of the Healthcare Team\u003c/em\u003e\u003c/p\u003e \u003cp\u003eNurses suggested integrating multidisciplinary teams, including psychologists, dietitians, diabetologists, and social workers, to enhance patient care.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"To enhance the care of individuals with diabetic amputations, we need all members of the healthcare team to be fully committed to patient care.\"\u003c/em\u003e (N6)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study underscores the complex interplay of emotional, resource-related, and systemic factors affecting nurses' ability to care for patients with diabetes-related amputations. The key themes identified include emotional and psychological challenges, resource constraints, systemic inadequacies, and recommendations for improvement. These findings were analyzed in comparison with existing literature to provide a comprehensive understanding of the challenges faced by nurses in both developed and developing countries.\u003c/p\u003e \u003cp\u003eNurses frequently experience empathy, helplessness, and frustration when caring for diabetic patients with amputations. Many nurses express deep emotional involvement, often internalizing patient suffering, a phenomenon commonly observed in low-resource settings [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In Ghana, where communal living and compassion are highly valued, nurses tend to form strong emotional bonds with their patients. However, heightened patient expectations exacerbate emotional distress, as nurses feel inadequate when unable to meet these expectations. Similar findings were reported by [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], who noted that unrealistic patient expectations contribute to the psychological burden on nurses in low- and middle-income countries.\u003c/p\u003e \u003cp\u003eIn contrast, nurses in developed countries also experience emotional distress; however, structured interventions such as counseling services, peer support groups, and employee assistance programs (EAPs) help mitigate these challenges [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. For example, the National Health Service (NHS) in the UK provides mental health and well-being support for nurses to reduce burnout and emotional exhaustion [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This structured support is largely absent in many developing countries, where nurses often lack institutional mechanisms to address emotional trauma. Establishing counseling units in public hospitals could provide crucial psychological support, as recommended by [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], who emphasized the need for structured mental health interventions to mitigate caregiver burnout.\u003c/p\u003e \u003cp\u003eA major challenge identified was the difficulty in building trust with patients. Many nurses struggle to manage patient expectations, leading to strained nurse-patient relationships. This aligns with the findings of [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], who highlighted that unmet expectations in chronic care settings often undermine trust. In developed countries, patient trust in healthcare professionals is often reinforced by clear communication strategies and structured patient education programs [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Nurses receive specialized training in breaking bad news, managing expectations, and fostering therapeutic relationships, which enhances patient compliance and satisfaction [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, in developing countries, nurses often lack such training, contributing to patient dissatisfaction and diminished trust in healthcare providers. Addressing these trust issues requires targeted training in effective communication strategies, patient education, and cultural competence. Incorporating these elements into nursing education could improve interactions between nurses and patients, ultimately enhancing treatment adherence.\u003c/p\u003e \u003cp\u003eThe management of diabetic stumps and the rehabilitation process are resource-intensive and demanding. Participants reported that proper wound care is essential for healing, a finding supported by [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], who emphasized the need for multidisciplinary collaboration in rehabilitation. Pain management emerged as a significant hurdle, with nurses describing patients\u0026rsquo; struggles with excruciating pain due to ischemia and infection. Some nurses noted that patients were often unable to sleep at night due to severe pain, a challenge echoed by [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], who identified inadequate pain relief options in low-resource settings as a critical issue in diabetic care.\u003c/p\u003e \u003cp\u003eDeveloped countries typically have access to advanced wound care technologies, prosthetic devices, and pain management options such as nerve blocks and specialized analgesics [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Conversely, nurses in developing countries frequently encounter shortages of essential medical supplies, including wound care materials, prosthetics, and orthotic devices. They often resort to improvisation due to these shortages, a situation mirrored in [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], which found that resource limitations in sub-Saharan Africa compromise healthcare quality. Addressing these gaps requires strategic policy interventions at institutional and governmental levels, prioritizing improved resource allocation, procurement of essential supplies, and increased funding for diabetic care programs.\u003c/p\u003e \u003cp\u003eParticipants strongly advocated for continuous professional development to enhance their knowledge and skills. This aligns with [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], who emphasized the role of in-service training in improving nursing care for patients with complex needs. Integrating specialized courses on diabetic wound care and rehabilitation into nursing education, alongside hands-on simulation-based training, could bridge existing knowledge gaps in amputation management.\u003c/p\u003e \u003cp\u003eIn developed countries, continuous professional development is often mandatory, with nurses required to update their skills through workshops, certification programs, and clinical training [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. These structured training programs ensure that nurses are equipped with the latest knowledge and best practices in diabetic care. However, in many developing countries, access to such training is limited due to financial constraints and a lack of institutional support [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Governments and healthcare institutions should invest in continuous education programs to ensure nurses receive ongoing training in diabetic wound care, pain management, and rehabilitation.\u003c/p\u003e \u003cp\u003eIn addition to training, nurses emphasized the need for better resource availability and the integration of multidisciplinary teams to improve patient care. They stressed that a collaborative approach involving nurses, physicians, psychologists, dietitians, and social workers would lead to more effective management of diabetic amputations. This finding resonates with [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], who highlighted the importance of team-based approaches in managing chronic conditions.\u003c/p\u003e \u003cp\u003eMultidisciplinary collaboration is well established in developed healthcare systems, where care pathways involve coordinated input from various healthcare professionals [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. However, in developing countries, a lack of structured teamwork and communication between health professionals often results in fragmented care. Structured care pathways that foster teamwork among healthcare professionals should be implemented to ensure a holistic approach to diabetic care.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study was conducted at a public hospital, which may differ in organizational structure and resources compared to private or rural hospitals. This context may influence the applicability of findings to other settings providing care to patients with diabetic amputations. The participants included general nurses from various surgical units, which may mean their knowledge and experiences are broad but not necessarily specific to the care of patients with diabetic amputations. The qualitative approach relies on subjective accounts, which may reflect individual experiences rather than universally applicable patterns. Additionally, the small and relatively homogenous sample size could limit the range of perspectives represented.\u003c/p\u003e \u003cp\u003eThe cultural and systemic context in Ghana likely shaped the findings, which may require careful consideration or adaptation when applied to different sociocultural and healthcare environments. Finally, resource constraints during the study may have restricted the depth of exploration into some aspects of care and challenges faced by nurses. Future research could address these limitations by conducting comparative studies across multiple healthcare settings, including private and rural hospitals, to explore variations in organizational structure, resources, and patient outcomes. Incorporating a mixed-methods approach with both qualitative and quantitative data could enhance the reliability of findings, balancing subjective experiences with measurable trends. Additionally, longitudinal studies could capture evolving trends in nursing care, resource availability, and systemic influences over time, offering a more nuanced and transferable understanding of the findings.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eImplementing structured mental health support programs for nurses facing emotionally taxing situations is essential for their well-being and professional effectiveness. Additionally, advocating for the inclusion of specialized diabetic wound care training in national nursing curricula can enhance patient outcomes and reduce diabetes-related complications. Prioritizing these initiatives will not only support nurses in their demanding roles but also improve overall healthcare quality.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Practice and Education\u003c/h2\u003e \u003cp\u003e There is a need to establish national guidelines to standardize diabetic foot care and amputation management, ensuring consistency in treatment and resource availability. Additionally, integrating mental health education into nursing curricula can equip nurses with coping strategies for the emotional challenges associated with chronic patient care. By addressing these implications, healthcare facilities can create an enabling environment for nurses to deliver quality care, thus improving patient outcomes and overall healthcare delivery in Ghana and similar settings.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was conducted in accordance with the Declaration of Helsinki. Data collection was done after obtaining approval from the Committee for Human Research Publication and Ethics (Ref: CHRE/AP/178/023) of the University of Energy and Natural Resources and a written permit from the Sunyani Teaching Hospital. An informed consent was obtained from all participants\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable (this manuscript does not report data generation or analysis)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research had no funding. All cost was borne by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBEA: Conceptualization, original draft, investigation, data collection, analysis,\u003c/p\u003e\n\u003cp\u003eAH: Conceptualization, analysis, validation, writing critical review and editing\u003c/p\u003e\n\u003cp\u003eCAA: Data collection, validation, review of the manuscript\u003c/p\u003e\n\u003cp\u003eTP: Validation, review and editing of the manuscript\u003c/p\u003e\n\u003cp\u003eRB: Data collection, validation, manuscript review and editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/em\u003e\u003cem\u003eDepartment of Nursing, School of Sciences, University of Energy and Natural Resources, Sunyani, Ghana\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003cem\u003eNursing, Holy Family Nursing and Midwifery Training College, Berekum, Ghana\u003c/em\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBoateng D, Ayellah BB, Adjei DN, Agyemang C. 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DOI: 10.1016/j.puhe.2024.01.019.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Diabetic amputation, nursing experiences, healthcare challenges, phenomenology, qualitative study","lastPublishedDoi":"10.21203/rs.3.rs-5891005/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5891005/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAmputation resulting from diabetes remains a significant public health challenge in Ghana, often leading to increased morbidity and mortality. Nurses serve as frontline healthcare providers in managing these patients.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThis qualitative study explores nurses' experiences and challenges in managing diabetic amputations at the Sunyani Teaching Hospital in Ghana.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eUsing a phenomenological approach, semi-structured interviews were conducted with 13 nurses working in the diabetic and surgical units of the Sunyani Teaching Hospital (STH) between April 2024 and July 2024.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study identified three key themes regarding nurses\u0026rsquo; experiences in managing diabetic amputations: emotional and psychological challenges, physical and resource constraints, and recommendations for improvement. Findings indicate that nurses face emotional burdens, resource limitations, difficulties in patient\u0026ndash;nurse relationships, and challenges in developing coping mechanisms while caring for patients with diabetes-related amputations.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe findings provide valuable insights into the challenges faced by nurses and suggest strategies for improving care delivery and outcomes for individuals with diabetic amputations.\u003c/p\u003e\u003ch2\u003eRecommendation\u003c/h2\u003e \u003cp\u003eTo enhance patient outcomes, nurses recommend improved training, better resource allocation, and interdisciplinary collaboration. Additionally, there is a need for structured mental health support programs for nurses coping with emotionally taxing situations. Emphasis is also placed on incorporating specialized diabetic wound care training into the national nursing curriculum.\u003c/p\u003e","manuscriptTitle":"Exploring Nurses' Experiences and Challenges in Managing Diabetic Amputations: A Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-27 04:17:43","doi":"10.21203/rs.3.rs-5891005/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-03-25T22:15:12+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-25T00:02:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"29378447071876922316102253958917658320","date":"2025-03-24T23:50:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-24T14:47:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-22T07:53:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-03-21T03:17:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8616c73e-16a6-4be2-9f76-39a86b834750","owner":[],"postedDate":"March 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-12T16:07:08+00:00","versionOfRecord":{"articleIdentity":"rs-5891005","link":"https://doi.org/10.1186/s12912-025-03143-4","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2025-05-08 15:57:19","publishedOnDateReadable":"May 8th, 2025"},"versionCreatedAt":"2025-03-27 04:17:43","video":"","vorDoi":"10.1186/s12912-025-03143-4","vorDoiUrl":"https://doi.org/10.1186/s12912-025-03143-4","workflowStages":[]},"version":"v1","identity":"rs-5891005","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5891005","identity":"rs-5891005","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}