Between culture and care: nurses’ experiences of end-of-life communication in Ghana

Background: Communicating at the end-of-life (EOL) requires deep sensitivity and adherence to strong ethical principles that respect the dignity, rights, and values of patients and their families. However, many nurses find this task emotionally challenging, especially in settings with limited training and strong cultural taboos about death. In Ghana, little is known about how nurses experience and manage these conversations in everyday clinical practice. This study explored nurses’ experiences communicating with families at the end of life. Methods: This study adopted an interpretivist qualitative design to explore the experiences of nurses at a district hospital in the Volta Region of Ghana. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guided the study. Twenty registered nurses with at least two years of clinical experience participated in in-depth, semi-structured interviews. Data were analysed inductively using Braun and Clarke’s reflexive thematic analysis approach. The research team engaged in continuous reflexive practice to ensure analytic rigor. Results: Three major themes were identified: (1) emotional and psychological challenges of breaking bad news, (2) coping mechanisms and professional obligations, and (3) institutional and cultural barriers to effective communication. Nurses described sadness, fear, and hesitation when informing families about death or poor prognosis, but they still viewed it as a core professional duty. Coping strategies included information gathering, teamwork, and personal faith. Communication was largely informal, with limited guidance or training. Cultural beliefs about death, family blame, and lack of privacy or institutional support further complicated interactions. Conclusion: Strengthening training, developing institutional guidelines, and incorporating cultural understanding into communication practices could help nurses deliver end-of-life care with greater confidence and support. Relevance to clinical practice: Communication during the end of life must be done correctly to convey the correct meaning of the message to the client and family. The findings will enable other nurses to identify with the experiences shared in this article and how to cope in such situations.