Psychosocial Challenges and Coping Strategies Among Nurses Providing Palliative Care in Africa: A Systematic Review

Around 56.8 million people require palliative care each year, and roughly three-quarters of them live in low- and middle-income countries (Connor, 2020). Most never receive it. Projections suggest that serious health-related suffering will nearly double by 2060, with the steepest proportional rises in low-income countries (Sleeman et al., 2019). Africa carries a large share of that unmet need. Provision has not kept pace. Palliative care development across the continent is uneven in service availability, education, policy support, opioid access and specialist capacity, and few countries have integrated services into mainstream health systems (Rhee et al., 2017). Restricted access to opioid analgesia leaves a substantial shortfall in pain relief concentrated in low- and middle-income settings (Knaul et al., 2018). Much palliative care is therefore delivered outside dedicated units by staff without specialist preparation (Maree et al., 2023). Nurses do most of this work. They assess symptoms, provide comfort, communicate deterioration, coordinate care, support relatives and stay present through dying and death (Sekse et al., 2018). Nurses and midwives make up roughly 37% of the health workforce in the WHO African Region, a workforce already marked by shortage and maldistribution (Ahmat et al., 2022). The proximity that gives nursing its value also exposes nurses repeatedly to grief, difficult conversations and ethical uncertainty. Internationally, sadness, anticipatory grief, helplessness, anxiety, emotional exhaustion, moral distress, burnout and compassion fatigue are all documented among palliative care professionals (Pereira et al., 2011; Sapeta et al., 2022). Coping ranges from problem-focused efforts that act on the demand itself to emotion-focused efforts that regulate the distress it produces (Lazarus & Folkman, 1984). Whether a given strategy protects or harms depends on context; emotional distancing may preserve short-term functioning while becoming disengagement over time (Uren & Graham, 2013). The African setting is distinctive rather than simply under-resourced. Workforce shortage places nurses in the position of knowing what a patient needs and being unable to provide it (Ahmat et al., 2022). Cultural conventions surrounding death, disclosure and family authority govern what may be said, to whom and by whom, while religious faith and communal solidarity function as coping resources that Western psychotherapeutic models do not readily accommodate (Gysels et al., 2011). These conditions interact with the emotional demands of the work rather than merely adding to them. Existing evidence is fragmented. Qualitative work describes how nurses understand death and seek support; quantitative work measures distress and burnout; neither strand alone gives a complete account. A recent meta-analysis of compassion fatigue among palliative care nurses included no studies from low-income countries at all (Chen et al., 2026), which illustrates how thinly African practice is represented internationally. Without a consolidated regional account, managers and educators risk adopting generic wellbeing programs that miss local realities, while the systemic origins of nurse distress go unaddressed. This review will address that gap. It asks what psychosocial challenges African palliative care nurses experience, what strategies they use to manage them, and what conditions shape both. The transactional model of stress and coping frames the analysis (Lazarus & Folkman, 1984), directing attention to appraisal, coping resources, responses and consequences, while remaining open to cultural, spiritual and organizational findings the model does not anticipate. Findings will inform institutional support provision, curriculum reform and national palliative care policy, and will support Sustainable Development Goal 3 and its commitment to universal health coverage sustained by a protected health workforce (United Nations, 2015).